bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intravenous epoprostenol therapy in the treatment of pulmonary arterial hypertension: the Singapore experience
Authors: Choo J , Yap J , Ismail AIDILA , Lim C L , Sumathy P , Ruan W , Sewa D W , Phua G C , Hong C , Low A H L , Lim S T , Tan J L 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Pulmonary arterial hypertension (PAH) is a progressive disease with significant morbidity and mortality. While intravenous (IV) Epoprostenol, a prostacyclin analogue, has been shown to improve exercise tolerance, symptoms, hemodynamics and survival, there are challenges with initiation and maintenance of this IV therapy.

Purpose
We aim to describe our local experience of the use of IV Epoprostenol in the treatment of PAH patients in Singapore, highlighting various issues and challenges.

Methods
From 2016, patients at a tertiary cardiac institution diagnosed with Group 1 PAH and remaining in intermediate to high risk class with progressive symptoms (despite being on maximum tolerable doses of PhosphoDiEsterase-5 inhibitors and Endothelin-1 receptor antagonists) were assessed and counselled for initiation of Epoprostenol therapy. With a fixed set of local protocols, comprehensive assessment and support of a multi-disciplinary team including physicians, specialist nurses and pharmacists, suitable patients were started on this treatment.

Results
A total of 12 patients (11 female, mean age 42.8 +/- 11.0 years) were included. The average New York Heart Association class of the patients initiated on Epoprostenol was II-III. The pulmonary artery pressures and pulmonary vascular resistance on right heart catheterization prior to initiation was 52.5 (IQR 47.0-54.0) mmHg and 12.6 (IQR 10.0-14.2) Woods respectively. The duration from diagnosis to time of initiating Epoprostenol was 89 (IQR 62-140) months. Epoprostenol was generally well tolerated. The most common side effect experienced was diarrhea (5/12 patients) followed by headache and musculoskeletal complains (3/12 patients each). Of the 12 patients, 6 passed away after 12 (IQR 10-16) months of Epoprostenol therapy. Of the remaining 6, PAH was diagnosed 110 (IQR 104-136) months ago and Epoprostenol therapy has been continued for 17 (IQR 14-27) months. Of those who survived, right ventricle size and PA pressures on echocardiography remained relatively stable as compared to those who passed on. 2 patients had line related infections requiring a line change 1 and 2 times respectively.

Conclusion
While not without its challenges, the establishment of concrete protocols with the support of a multidisciplinary team allows for the introduction of IV Epoprostenol as an additional potential line of effective therapy for PAH patients in Singapore.
The Clinical Experience of Macitentan in pulmonary hypertension in Indian cohort: 12-months follow-up
Authors: Jariwala PANKAJ , Jadhav KARTIK 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
AIM AND OBJECTIVE
Macitentan, an endothelin receptor antagonist, has been shown to be effective and safe in the treatment of pulmonary arterial hypertension (PAH) in multiple randomized clinical trials, including SERAPHIN, focusing on morbidity and mortality reduction. The goal of this study was to show the clinical and echocardiographic improvement with macitentan in Indian patients with PAH.

METHODS
We conducted a retrospective study of 20 patients with various etiologies of PAH who received macitentan treatment in a single institution between June 2018 and June 2019. Of the total cases, 55% of the patients took conventional PAH therapies. We assessed the World Health Organization functional class (WHO-FC), 6-minute walking distance (6MWD), N-terminal prohormone brain natriuretic peptide level (NT-pro-BNP), and echocardiographic data such as tricuspid annular plane systolic excursion (TAPSE), systolic pulmonary artery pressure (sPAP), and the presence of pericardial effusion at baseline and 12-month follow-up.

RESULTS
The study involved 20 PAH patients, 70 % of whom were female. The majority (50%) were in WHO FC II, while 35% were in FC III, and 15% were in FC IV. At the start of the macitentan therapy, the average age was 43.4 years. After 12-months of macitentan medication, 85% of patients showed significant improvement in their FC, 6-minute walking distance test (p &lt; 0.0001; Fig.-1), and plasma levels of NT-pro BNP were significantly reduced (p &lt; 0.0001). Echocardiographic parameters such as TAPSE and sPAP have also improved (p &lt; 0.0001).

CONCLUSION
Our findings indicate that macitentan has been well-tolerated and beneficial in Indian patients with PAH, and further future research is required to verify these results. Abstract Figure.
Direct oral anticoagulant vs low molecular weight heparin for the treatment of venous thromboembolism associated with malignancy: a meta- analysis
Authors: Lastimosa H 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Venous thromboembolism (VTE) is a major cause of morbidity and mortality in cancer patients and treatment of cancer associated thromboembolism is challenging. Low molecular weight heparin (LMWH) has been the standard of care treatment for cancer-associated VTE yet the use of direct oral anticoagulant (DOACs) has been promising.

Purpose
To determine the efficacy and safety between direct oral anticoagulants compared to low molecular weight heparin in recurrent VTE prevention cancer associated thromboembolism.

Method
Randomized controlled trials (RCT) comparing DOACs with LMWH for treatment of VTE in cancer patients.

Results
Four randomized controlled trials were selected which included a total of 2,894 participants enrolled in 4 randomized controlled trials, with a mean follow-up of 6-12 months. As a pooled aggregate, oral anticoagulant is beneficial over dalteparin in the prevention of recurrent VTE. (RR 0.75; 95% CI, 0.59-0.95; I2 59%). The safety of oral anticoagulant compared to dalteparin, there was statistically no significant difference in the major bleeding risk. (RR 1.35; 95% CI, 0.93-1.94; I2 28%). Sub-group analysis of clinically relevant non major bleeding however favors the dalteparin over oral anticoagulant. (RR 1.59; 95% CI, 1.23-2.05; I2 41%).

Conclusion
In this meta-analysis, the efficacy of direct oral anticoagulant in terms of recurrent VTE prevention for patients with cancer is favorable or at least similar to that of dalteparin. Though safety profile has no significant difference in terms of major bleeding between the two groups, oral anticoagulants has a higher risk of clinically non-major bleeding. Abstract Figure. Forest plot for recurrent VTE Abstract Figure. Forest plot for major bleeding
Three year clinical outcomes of fractional flow reserve guided coronary revascularization using a monorail pressure sensor microcatheter
Authors: Bhavnani C D , Koh K T , Oon Y Y , Pang I X , Tan C T , Chen L S , Shu F E P , Ho K H , Cham Y L , Ling H S , Said A , Thien L K , Chung B K , Fong A Y Y , Ong T K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.
Background
Fractional flow reserve (FFR) has a Class 1A recommendation for guiding coronary revascularization in stable coronary artery disease. Deferral of revascularization for coronary stenosis of FFR &gt;0.80 has shown favorable long-term outcomes, yet the adoption in real-world practice is limited. To date, there is no study on FFR guided PCI in the Malaysian population.
Objective
(1) To explore the 3-year clinical outcome of FFR guided coronary revascularization.
(2) To compare the clinical outcome of FFR guided deferral of coronary revascularization versus FFR guided revascularization. The primary outcome was a composite of all cause mortality, non fatal myocardial infarction (MI) and ischemia driven target vessel revascularization (TVR)
Results
Thirty-five patients were lost to follow up leaving 78 patients (95 vessels) for final analysis. The mean age was 59.3 ± 9.4 years old. 69 (88.5%) patients were male, 24 (30.7%) had diabetes mellitus, 58 (74.3%) had dyslipidemia, 61 (78.2%) had hypertension and 45 (57.7%) were smokers. The mean LVEF was 56.7 ± 14.7%. FFR to the LAD artery was performed in 64 (82%) patients. Based on the FFR value of 0.80, 47 (60.2%) patients had FFR guided deferral of coronary revascularization and 31 (39.7%) patients had FFR guided revascularization.
At 3 years, 11 (14.1%) patients met the primary outcome, mainly driven by all-cause mortality (11.5%). The primary outcome was met in 14.9% of FFR guided deferral versus 12.9% of FFR guided revascularization (p = 0.828). All-cause mortality was 12.7% in patients with FFR guided deferral compared to 9.7% in patients with FFR guided revascularization at 3 years (p = 0.712).
Cox proportional hazards model did not demonstrate any independent predictors associated with the primary outcome or all cause mortality.

Conclusion
FFR guided deferral of revascularization was safe and had comparable long-term clinical outcomes to FFR guided PCI. To our knowledge, this is the first study on long-term clinical outcome on FFR guided revascularization in Malaysia. Abstract Figure. Kaplan-Meier curve primary end point Abstract Figure. Kaplan-Meier curve all cause mortality
Standardized LocSSIPs improves risk prevention for in-patient angioplasty in tertiary care hospital
Authors: Kyaw K 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
acute cardiovascular care

Introduction
There are no established ESC/NICE guidelines for acceptable Safety Checklists in invasive coronary angiogram. A lack of Quality Assurance Checklists that is indicated by WHO guidelines for coronary angiogram can lead to potentially serious or life-threatening implications such as acute pulmonary and venous thromboembolism, stent thrombosis due to delays in anti-platelet therapy and thromboprophylaxis.

Purpose
A LocSSIPS audit was conducted to investigate poor compliances of Patient Safety Checklists that are indicated per WHO guidelines. Further objectives were to understand the reasons for poor compliance and to formulate local guidelines to standardize checklists for angioplasty.

Methods
A total of 50 patients were assessed for poor compliance in safety checklists from 1st April 2021 to 16thJuly 2021.Out of these 30 received coronary angioplasty (study population for the audit). Poor compliance counted from the day evidence to implants was recorded in local Safety checklist elements. Compliance was assessed in different steps as compliances in anti-platelet therapy, Venous Thrombo-prophylaxis and female aged 11-55 years taken pregnancy test prior radiation exposure and implant verification. An acceptable audit standard was devised as 100% of compliance in Safety Checklists for all patients undergoing angioplasty.

Results
It was found that only 20 out of 30 patients (67%) achieved the audit standard of FULL compliance. In 10 of the 30 patients, who did not meet the audit standard, the main reasons are lack of VTE prophylaxis, anti-platelets drugs, and implant sterility. A standardized safety checklist was hence devised to improve upon quality of angioplasty. This involved designating the on-call cardiology registrar to flag up the Venous Thrombo- prophylaxis and anti-platelet therapy checks for patients undergoing invasive coronary angiogram. An electronic LocSSIPs checklist was also devised with alerts to Interventional cardiologists and the procedure booking team. A multi-professional team discussion of raising poor compliance is held in the monthly Clinical Governance meeting as a quality control measure with creation of an Ongoing annual re-audit following implementation of recommendation.

Conclusion
The incorporation of audit recommendations in local cardiology guidelines has led to significant improvement in patient quality of care and potential reduction in risk of serious outcomes due to poor compliance in safety checklists for invasive coronary angiogram. Abstract Figure. Overall Score Percentage Data Analysis Abstract Figure. Average Percentage Score Data analysis
Initial clinical experience with a new sheathless guiding catheter designed for direct insertion
Authors: Borrie A , Fairley S , Harding S A 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Radial access for percutaneous coronary intervention (PCI) is growing rapidly as this approach has been shown to improve patient comfort and reduce complications. Use of a sheathless guiding catheter for transradial PCI has the potential reduce trauma to the radial artery and to further expand the type of cases where this approach can be utilised. The new Sheathless Hyperion system allows direct insertion of the Sheathless Hyperion guiding catheter using a 20 G needle or IV cannula, a 0.25" Silverway wire and a custom dilator.

Purpose
We report the first clinical experience with the new Sheathless Hyperion guiding catheter designed for direct insertion.

Methods
We prospectively evaluated outcomes in consecutive patients who underwent PCI using the Sheathless Hyperion catheter at our institution between June 2020 and March 2021. All procedures were performed via radial access. There were no exclusion criteria.

Results
Eighty one patients were included with 99 lesion being treated using 85 Sheathless Hyperion catheters. Mean age 67.7 ± 11.8 years, 77.8% male, 22.2% diabetic and 38.8% had acute coronary syndromes. The Sheathless Hyperion was inserted directly into the radial artery in 46 (54.1%) cases with 100% success rate and inserted following initial sheath insertion for the remaining 39 (45.9%). Of the Sheathless Hyperion catheters used 30 (35.3%) were 6F in 55 (64.7%) were 7F. The Sheathless Hyperion was passed into the ascending aorta successfully in all cases. The target coronary artery was successfully engaged in 85 (98.8%). In one case the coronary could not be engaged because of excessive brachiocephalic tortuosity and conversion to femoral access occurred. In 4 cases the Sheathless Hyperion catheter had to be exchanged for one with a small curve. The majority of lesions were complex: 18.2% CTO, 39.4% heavily calcified, 44.4% long lesions and 31.3% bifurcation lesions. Adjunctive devices included rotational atherectomy (12.1%), intravascular lithotripsy 14.1%, IVUS (56.6%) and OCT (28.3%). Angiographic success was achieved in 100%. Peri-procedural non-ST-elevation myocardial infarctions defined by the 4th Universal definition occurred in 3 (3.7%) patients. No patient meet the SCAI criteria for periprocedural MI. There was no in-hospital target vessel revascularisation or death. Radial artery occlusion was infrequent occurring in one patient. No major haematomas or vascular complications occurred.

Conclusion
First clinical experience with the Sheathless Hyperion demonstrates that direct insertion is safe and effective and that it allows complex interventions to be undertaken transradially with a high success rate.
Early impact of COVID-19 pandemic on heart transplant volumes in Asia and Oceania: results from the Global Observatory on Donation and Transplantation (GODT)
Authors: Manla Y , Bader N , Bajwa G , Gobolos L , Alsindi F , Hamour I , Ghalib H , Al Badarin F 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Massive demand for healthcare services worldwide following the emergence of coronavirus disease 2019 (COVID-19) has limited the availability of healthcare resources needed for certain high-complexity procedures, including orthotopic heart transplantation (OHT). Whereas the negative impact of COVID-19 pandemic on several elective procedures has been well-documented, data on regional changes in OHT volumes after COVID-19 are limited. Therefore, we aimed to quantify the impact of COVID-19 pandemic on OHT volumes in Asia and Oceania.

Methods
Using data from the Global Observatory on Donation and Transplantation (GODT), the world"s most comprehensive source of data on organ donation and transplantation, we recorded the number of OHT procedures performed in years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). The analysis was limited to countries with reported OHT data within Asia and Oceania (Australia, China, India, Iran, Israel, Japan, New Zealand, Russian Federation, Saudi Arabia, Thailand, Turkey, and the United Arab Emirates). OHT rates were reported for each country per million population (PMP), and change in the COVID-19 era was reported as percentage of the pre-COVID-19 rates. The association of total COVID-19 cases with relative reduction in OHT was evaluated using linear regression.

Results
Across the Asia/Oceania region, number of OHT in COVID-19 era (median 0.64 procedures PMP, IQR 0.28, 2.15) was significantly lower compared with the pre-COVID-19 era (median 1.18 procedures PMP, IQR 0.49, 2.50), with a median change of -0.29 (IQR -0.70, -0.08; P = 0.04). The impact of COVID-19 on OHT was most pronounced in Turkey, United Arab Emirates, and India, where OHT volumes decreased by 75.4%, 60.8%, and 53%, respectively. Country-level reduction in OHT volumes was not associated with total number of COVID-19 cases during the year 2020 in that country (r = 0.31; P-value = 0.3).

Conclusion
The number of heart transplants during the early phase of COVID-19 pandemic significantly decreased in ­­­most countries of the Asia/Oceania region. Furthermore, the change in OHT volumes did not correlate with the total number of recorded COVID-19 cases, suggesting the pandemic’s impact on OHT numbers extended beyond limiting availability of resources. Identifying factors leading to OHT deferral during COVID-19 pandemic will advance our understanding of the pandemic’s true impact on the care of advanced heart failure patients in the region. Abstract Figure.
Can cord blood lipid and lipoprotein levels inform LDL targets?
Authors: Tan J W C , Yeo K K , Phua S K , Lee J J B , Koh N S Y , Aw T C 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Current ESC dyslipidemia guidelines recommend lowering LDL targets to 1.4mmol/L (55mg/dL) for very high risk individuals. Lipid levels of newborns may provide insights into physiologic levels at the time of birth. There is limited data on cord blood lipids/lipoprotein levels in Asian populations. This study aims to describe cord blood lipid levels in a multi-ethnic Asian population.

Methods
We analyzed 563 (F = 275) anonymized residual cord serum samples for the measurement of cholesterol, triglycerides, dLDL and HDL on the Cobas c702 autoanalyzer and cLDL after exclusion of outliers (Tukey). Following tests for Gaussian distribution (Shapiro-Wilk) all data were log transformed. Gender differences were assessed by Mann-Whitney U test. dLDL was compared with cLDL (Passing-Bablok regression, Wilcoxon’s test, Bland-Altman plot). Statistical calculations were performed using MedCalc v20 (MedCalc software, Ostend, Belgium).

Results
There was no gender difference for cord cholesterol (p = 0.1781) and cLDL (p = 0.6186) and their values were: cholesterol (range:0.78-3.09mmol/L; mean:1.486; reference interval:0.92-2.42) and cLDL (range:0.19-1.85mmol/L; mean:0.60 ; reference interval:0.27-1.21). dLDL was higher in females (p = 0.0388) (range:0.17-1.84mmol/L; median:0.54; IQR:0.37,0.71; reference interval:0.22-1.26; 99th percentile 1.42) compared to males (range:0.16-1.19mmol/L; median:0.49; IQR:0.36,0.62; reference interval:0.21-0.98; 99th percentile 1.13). Cord dLDL values were significantly lower (p &lt; 0.001) than cLDL; the difference (Bland-Altman) between dLDL and cLDL ranged from -0.2062-0.0141 mmol/L (mean -0.0960). Passing-Bablok regression analysis showed cLDL = 1.0465dLDL + 0.0695 with a correlation coefficient (Spearman) of 0.963 (p &lt; 0.0001). Female triglycerides were lower (p &lt; 0.0001) [range:0.11-0.82mmol/L; median:0.24; IQR:0.19,0.31; reference interval:0.11-0.64] than males [range:0.11-0.85mmol/L; median:0.28; IQR:0.21,0.38; reference interval:0.13-0.66]. HDL was higher in females [range:0.40-1.62mmol/L; median:0.75; IQR:0.62,0.93; reference interval:0.44-1.34] than males [range:0.33-1.29mmol/L; median:0.69; IQR:0.58,0.86; reference interval:0.43-1.16] (p = 0.005).

Conclusion
Contemporary cord blood lipid/lipoprotein values have been derived for our local multi-ethnic Asian population. Directly measured LDL, shows ESC guideline LDL targets are not lower than cord dLDL levels at the 99th percentile. However cLDL overestimates cord dLDL in this cohort of subjects.
Effectiveness of a home-based cardiovascular disease prevention program during the COVID-19 pandemic
Authors: Chockalingam P , Natarajan V , Sekar T , Rajaram A , Yusuf M M , Gunasekaran S , Nayar P G , Chockalingam V 
Published: February 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Home-based cardiovascular disease (CVD) primary prevention (HBPP) and cardiac rehabilitation (HBCR) programs which occupied a small proportion of the overall Preventive Cardiology work in the past have become mainstream during the COVID-19 pandemic.

Purpose
This study aims to analyse the effectiveness of a home-based CVD prevention program implemented during the pandemic in India.

Methods
A retrospective study was conducted on pre-pandemic and pandemic enrolees. Health behaviour, CVD risk factors, physical and mental component score (PCS, MCS) from SF-12 questionnaire, body mass index (BMI), 6-minute walk distance (6MWD), and clinical and biochemical parameters were assessed. A multidisciplinary team consisting of Physician, Physiotherapist, Dietician and Counselling Psychologist provided the program using tele-health platforms.

Results
Of the 66 subjects (55 ± 13 years, 73% male), 17 (26%) enrolled pre-pandemic and 49 (74%) enrolled during-pandemic, 28 (42%) were HBPP and 38 (58%) were HBCR participants. Majority of the subjects (n = 51, 77%), with significantly more HBCR than HBPP participants, harboured 4 or more risk factors (p = 0.04). In the 60 (91%) program completers, BMI, 6MWD, PCS and MCS had improved significantly. SBP, DBP, LVEF, HbA1c, total cholesterol and LDL had improved significantly in affected subjects. Completely home-based participants (n = 44, 67%) who never had any in-person contact with the team during the program also showed significant improvement. No adverse events were reported.

Conclusion
Comprehensive home-based CVD prevention programs are effective in improving anthropometric, clinical, biochemical and psychosocial parameters, are a safe alternative to conventional programs and could potentially become the standard-of-care in the post-pandemic era. Abstract Figure. Outcomes in program participants Abstract Figure. Management of ACS in participants