bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left ventricular diastolic function in patients with breast cancer under chemotherapy
Authors: Tinoco M , Dias G , Cardoso F , Pereira T , Lima B , Oliveira L , Von Hafe P , Azevedo O , Leite S , Lourenco A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Chemotherapy, in particular anthracyclines (A) and trastuzumab (T), have improved disease-free survival and overall prognosis in patients with breast cancer (BC). The use of these two different types of agents may increase myocardial injury and cancer therapy-related cardiac dysfunction (CTRCD). CTRCD is defined as a reduction of left ventricular ejection fraction (LVEF) &gt;10% to a value &lt;50% or as a relative reduction of global longitudinal strain (GLS) &gt;15%. However, the role of diastolic dysfunction has been insufficiently researched.

Purpose
We sought to evaluate the impact of cardiotoxic treatments on left ventricular diastolic function.

Methods
Retrospective study of patients with first non-metastatic BC treated with A and/or T between Jan 2017 and Dec 2018 who underwent a comprehensive echocardiographic examination before, during, and after chemotherapy. We evaluated parameters of diastolic function derived from pulsed wave doppler interrogation of the mitral valve inflow (E/A ratio and mitral E-wave deceleration time (EDT)) and tissue doppler (E/E’ ratio).

Results
We included 128 patients, all female with median age of 54±11 years-old, treated with A (78; 60.9%), T (14; 10.9%) or A followed by T (36; 28.1%).
At the end of A therapy, E/A ratio (p=0,056), EDT (p=0,156) and E/E’ ratio (p=0,319) and left atrial volume index (LAVI) (p=0,056) did not show significant changes. At 2 years of follow-up, these parameters did not differ compared to baseline.
During T therapy, diastolic parameters did not differ from baseline. At the end of T therapy (with or without A), E/E’ ratio had a statistically significant increase (8,61±2,61 vs 9,70±3,59, p&lt;0,05) but no changes in EDT (p=0,461) or E/A ratio (p=0,464) occurred. At 2 years of follow-up, EDT had a statistically significant increase (204,90±44,24 vs 229,10±58,53, p&lt;0,05) but no changes in E/A ratio (p=0,476) or E/E’ ratio (p=0,499) occurred.

Conclusion
In our sample of women with BC who underwent chemotherapy, early significant changes in diastolic parameters did not occur. One parameter of diastolic dysfunction was changed at 2 years of follow-up. In this study, BC chemotherapy has a very modest impact on LV diastolic function. Randomized studies on larger population are required. Other parameters should be considered to determine the diagnostic and prognostic role of LV diastolic function in CTRCD.
Impact of coronavirus disease 19 (COVID-19) pandemic on gender differences of acute coronary syndromes admissions and in-hospital outcomes
Authors: Simoni L , Alimehmeti I , Ceka A , Gina M , Tafaj E , Dibra A , Goda A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The incidence of acute coronary syndromes (ACS) decreased during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding gender differences in ACS admissions and outcomes during the pandemic that presented divergent results.

Purpose
The impact of COVID-19 pandemic on male and female ACS admissions and in-hospital outcomes.

Methods
A retrograde single-center study was conducted, collecting data for ACS admissions from March 9th (first COVID-19 case) until April 30th2020, compared with the same period of 2019. ACS admissions were classified as ST-elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), and unstable angina (UA). Incidence rate ratio (IRR) was used to compare all-ACS and subgroups admissions, and risk ratio (RR) to compare overall/male/female mortality.

Results
There were 321 ACS patients (238 males, 83 females) during the pandemic period and 550 patients (400 males, 150 females) during 2019. The IRR of all-ACS/males/females were significantly lower during COVID-19 period,respectively 0.58 (0.44-0.76), 0.59 (0.43-0.75) and 0.55 (0.37-0.74). The IRR for STEMI was significantly lower among females (0.59[0.39-0.89]), but not in males (0.76 [0.55-1.08]). The IRR for NSTEMI was lower but unsignificantly, meanwhile for UA it was significantly lower for both, males (0.40 [0.24-0.51]) and females (0.50 [0.33-0.84]). The overall ACS mortality was importantly increased during the COVID-19 period (7.4% vs. 3.4%) RR=2.16 (1.20-3.89). Significant increase was found in males (7.45% vs. 2.5%) RR=3.02 (1.42-6.44), but not in females (7.2% vs. 6%) RR=1.20 (0.44-3.27).

Conclusions
Admissions for ACS were reduced similarly in males and females during the COVID-19 pandemic. Main reductions were observed in UA group similarly in both genders and in STEMI predominantly in females. While we identified a substantial increase in the overall ACS mortality, significant increase was observed only in males reducing the differences between genders. Further studies are necessary for a better understanding of the increase in male mortality during this period.
Cardiovascular disease in critically ill COVID-19 patients
Authors: Lopes V , Baptista J P , Moreira N , Goncalves L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background/Introduction
It is now well known that patients with COVID-19 have a high prevalence of cardiovascular disease. COVID-19 is also associated with a substantial degree of cardiovascular involvement. However, the impact of cardiovascular disease (CVD) and cardiovascular risk factors on the natural history of COVID-19 is much less characterized.

Purpose
To characterize the prognostic impact of CVD and cardiovascular risk factors in COVID-19 patients admitted to an Intensive Care Unit (ICU).

Methods
We retrospectively analyzed patients consecutively admitted to an ICU with COVID-19, with a median follow-up of 10 months. Patients who either died or were discharged in the first 48 hours of admission were excluded.
Three groups were identified: (1) established CVD – presence of either heart failure, coronary artery disease and/or peripheral artery disease; (2) at higher risk of CVD – arterial hypertension, dyslipidemia, diabetes mellitus and/or smoking, in the absence of established CVD; and (3) at lower risk of CVD – i.e. none of the above.
Groups were compared, with special interest regarding in-hospital mortality, duration of mechanical ventilation, length of hospitalization. Global mortality (in-hospital and during follow up), and re-hospitalization were also compared. To compare survival, a Kaplan-Meier and multivariate Cox regression analysis were performed.

Results
Overall, 219 patients were identified, mean age was 62.1 ±11.9 years, 67.1% were male, 71 (32.4%) died in the ICU, 78 (35.6%) died during follow-up, and 14 (6.4%) were re-hospitalized.
30 patients (13.7%) had established CVD, 144 (65.8%) were at higher risk of CVD, and 45 (20.5%) were at lower risk of CVD. Patients with established CVD were older than patients at higher risk of CVD, and both were older than patients at lower risk (68.0 ±8.4 vs 62.0 ±11.3 vs 56.0 ±13.0 years, p &lt;0.001). ICU mortality was 56.7%, 30.6%, and 22.2% for patients with established CVD, at higher risk of CVD, and at lower risk of CVD, respectively (p = 0.005). Re-hospitalization rate, ICU length of stay, and duration of mechanical ventilation were similar among groups.
Patients with established CVD were at significantly higher risk of ICU mortality (HR 2.42, 95% CI 1.08-5.46, p = 0.033), and higher risk of global mortality (HR 2.16, 95% CI 1.03-4.52, p = 0.042), compared to patients at higher and lower risk of CVD; in patients at higher and lower risk of CVD, ICU and global mortality was similar. In multivariate Cox regression, after adjusting for age and risk scores, established CVD was not an independent predictor of mortality. Kaplan-Meier survival curves are presented in figures 1 and 2.

Conclusion(s)
Almost 80% of patients admitted to an ICU with COVID-19 had established or were at higher risk of CVD. Patients with established CVD have a higher risk of death, although its presence is not an independent predictor of death.
Sex differences in treatment and outcome of patients with cardiogenic shock complicating acute myocardial infarction
Authors: Holle S , Josiassen J , Helgestad OKL , Schmidt H , Holmvang L , Jensen LO , Ravn HB , Moeller JE , Fosboel EL , Thoegersen M , Hassager C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Differences in outcome between men and women among patients with acute myocardial infarction (AMI) have previously been investigated[1–4], while evidence concerning sex differences in patients with AMI complicated by cardiogenic shock (AMICS) is limited.

Purpose
The aim of this study was to investigate sex differences in patients with AMICS related to demographics, treatment and long-term outcome.

Methods
All adult patients (age ≥18 years) with AMICS hospitalized at one of two tertiary heart centers with a catchment area corresponding to 4 million citizens were included in this study. In the study period from January 1st, 2010 to December 31st, 2017, a total of 1716 AMICS patients were identified following individual validation. Data regarding patient characteristics, treatment and clinical outcome including short-term follow-up were extracted from medical records and an 8,5-year long-term follow-up were obtained from the national patients registry. A multivariate cox regression model was used to adjust for significant sex differences known to be associated with outcome in AMICS including age and an out-of-hospital cardiac arrest (OHCA) presentation.

Results
Of the 1716 included AMICS patients, 438 (26%) were women. Women were older than men, 71±12 years and 66±11 years, P=&lt;0.0001, respectively. Patients characteristics were similar between sex except for hypertension which was more common among women. Women were more often initially admitted to a local hospital (41% women and 30% men, P=&lt;0.0001), while more men presented with OHCA (25% women and 48% men, P=&lt;0.0001), which persisted after adjustment for age. At the time of shock development, women and men were comparable regarding blood pressure (mean: both 82 mmHg, P=0.44), heart rate (mean: 88 vs. 85 bpm, P=0.10), p-lactate (median: 5.2 vs. 5.5 mM, P=0.07), and left ventricular ejection fraction (median: both 30%, P=0.11). However, fewer women were treated with mechanical circulatory support (19% women and 26% men, P=0.002), which persisted following multivariate adjustment. Additionally, women were associated with a lower use of acute revascularization (83% women and 88% men, P=0.006) including percutaneous coronary intervention (n=1405) and coronary artery bypass graft (n=101) and mechanical ventilation (67% women and 82% men, P=&lt;0.0001). These significant signals did not remain following cox regression analysis. Women had a significantly higher short-term as well as long-term mortality rate, which persisted in the multivariate model (Figure 1).

Conclusion
Women were associated with lower use of mechanical circulatory support devices among AMICS patients. Women had a significantly higher short- and long-term mortality rate compared to men.
Outcomes in patients with acute heart failure treated with levosimendan: the impact of right ventricular function
Authors: Costa D , Tapia K , Barbosa B , Acosta MF , Cattaneo JP , Catena E , Muzzio M , Gregorietti V , Coronel R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Despite recent advances, acute heart failure poses a therapeutic challenge due to its high morbidity and mortality both in the short and long term. Particularly, right ventricle failure is associated with worst outcomes.
Levosimendan has emerged as an option and its use is the object of ongoing investigation. Its mechanism of action relies both on troponin C calcium sensitization to improve contractility and ATP-dependent potassium channels activation of promoting vasodilation. These actions cause well-established effects on the function of the left ventricle and systemic circulation, but little is known of the role of the right ventricle.
We aimed to compare the outcomes of patients who received levosimendan regarding the presence of right ventricular failure.

Methods
Single-center retrospective study, including all hospitalized adult patients that received levosimendan for acute heart failure from 2011 to 2020. Cardiac surgery patients were excluded. Right heart failure was assessed by echocardiography and categorized as normal or mildly, moderately, or severely reduced. Acute kidney injury was defined as a creatinine increase of ≥ 50% or ≥ 0.3 mg/dl from its baseline.

Results
A total of 52 patients were included for analysis. Their basal characteristics are described in table 1. All 3 patients (5.8%) that died during hospitalization showed right ventricular dysfunction. Acute kidney injury was more common in patients with right ventricular dysfunction (36.4% versus 10.5%, p = 0.04), as can be seen in figure 1. There were 9 cases of hypotension (17.3%), with no significant differences between groups.

Conclusion
In patients, hospitalized with acute heart failure who received levosimendan, right ventricle failure with associated with worst outcomes, particularly with acute kidney injury.
Use of levosimendan in acute heart failure: readmissions, mortality and impact on NT-proBNP
Authors: Silva G , Silva M , Caeiro D , Queiros P , Ferreira D , Brandao M , Fontes-Carvalho R 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Acute heart failure (AHF) is a complex clinical condition associated with high morbidity and mortality. Treatment of AHF remains a therapeutic challenge, with inotropic agents playing an important role. Levosimendan (LVS) is distinguished from other catecholaminergic inotropic by its three mechanisms of action - inotropic, vasodilator and cardioprotection - and by the presence of a long-acting metabolite.

Objective
We aimed to characterize the predictors of mortality and readmission rate following AHF hospitalizations treated with LVS.

Methods and Results
This is a retrospective analysis of all 69 patients treated with LVS in a Cardiology Department at a Tertiary Center (84% male, mean age 65 ± 13 years and mean left ventricular ejection fraction 27 ± 12%).
30-day and 6-month mortality was 23.2% and 36.2%, respectively. Risk factors for 30-day mortality (p &lt;0.05) were: obesity (41% vs 17%), absence of valvular heart disease (48% vs 13%) and plasma creatinine (pCr) variation after LVS infusion (+0.05 mg/dL vs -0.24 mg/dL). Patients with ischemic heart disease have higher mortality at 6 months (68% vs 25%, p=0.001). Risk factors for both 30-day and 6-month mortality (p&lt;0.05) were: chronic kidney disease stage ≥3 (40% vs 10%; 63% vs 15%), pCr before LSV (1.97 vs 1.43mg/dL; 1.83 vs 1.48mg/dL) and pCr after LVS (1.82 vs 1.23mg/dL; 1.71 vs 1.22mg/dL).
The readmission rate at 30 days and 6 months was 7.4% and 36.0%, respectively. We did not find any significant predictors for 30-day readmission. Factors associated with higher readmission rate at 6 months (p &lt;0.05) were: pre-infusion NYHA IV class (71% vs 30%), decompensated chronic HF (44% vs 9%) and atrial fibrillation or atrial flutter rhythm (56% vs 26%).
In 27 cases, pre and post treatment NT-proBNP values were available. LVS therapy significantly reduced NT-proBNP from 10467 ± 8984 ng/L to 8237 ± 9500 ng/L (p=0.012) and improvement was observed in 93% of patients. Survival at 30 days and 6 months can be predicted by percentage of NT-proBNP improvement (-84.4% vs -28.4%, p=0.047; -92.3% vs -16.3%; p=0.012).

Conclusion
AHF patients requiring inotropic therapy have high mortality and readmission rates. Several clinical features and analytical responses to LVS perfusion are predictors of these events.
LVS significantly reduces NT-proBNP. The magnitude of this reduction is a predictor of short- and long-term mortality.
Timing and causes of death in acute myocardial infarction complicated by cardiogenic shock
Authors: Witten Davodian L , Larsen JKP , Povlsen AL , Josiassen J , Helgestad OKL , Udesen NLJ , Hassager C , Schmidt H , Kjaergaard J , Holmvang L , Jensen LO , Ravn HB , Moeller JE 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Danish Heart Foundation
Odense University Hospital and Rigshospitalets Research Council.

Background
Acute myocardial infarction complicated by cardiogenic shock (AMICS) comprises a heterogenous population with high mortality. Insight in timing and cause of death may improve understanding of the condition and aid individualization of treatment.

Purpose
To determine the cause and timing of death in patients admitted with AMICS.

Methods
This was a retrospective, multi-center observational cohort study based on 1716 AMICS patients treated during the period of 2010-2017, of whom 904 died prior to hospital discharge from either of two tertiary cardiac centers in Denmark providing advanced care for cardiogenic shock for 3.9 million inhabitants. Patients admitted with AMICS were identified through national registries and review of individual patient charts. Only patients dying during hospitalization were eligible. Cause of death was categorized as caused by progressive cardiac failure, multi organ failure or due to neurological damage. Time to death was calculated in hours from first medical contact to death.

Results
Among 904 patients with AMICS who died prior to hospital discharge (median age 72 years [IQR: 63 - 79], 70% men), 342 (38%) patients had suffered an out-of-hospital cardiac arrest (OHCA). The most frequent cause of death was primary cardiac (54%), whereas 24% died of neurologic injury and 20% of multi-organ failure. Time to death was 13 hours [IQR: 5, 43] for cardiac failure; 140 hours [IQR: 95, 209] in neurological injury; and 137 hours [IQR: 59, 321] in multi-organ failure, p&lt;0.001. The causes of death in patients presenting with OHCA were neurological injury in 57%, as opposed to 4% among patients not presenting with OHCA, p&lt;0.001. No specific phenotype on admission characterized patients with OHCA who died from neurological injury or cardiac causes.

Conclusion
In patients with AMICS, cause of death was mainly primary cardiac failure followed by neurological injury and multi-organ failure. Median time from first medical contact to death was only 13 hours in patients dying from cardiac causes. The risk of dying of neurological injury was low in patients without OHCA.
Which is the best reperfusion therapy in patients with acute pulmonary embolism?
Authors: Iwanowski M , Bilbao J , Bonorino J , Melchiori R , Fernandez H , Torres N , Costantini R , Marquez S , Rubio P , Spaini M , Santucci J , Aris Cancela ME , Bivort M , Garcia Juarez G , Baratta S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Pulmonary embolism (PE) represents the third most common cause of cardiovascular death. Reperfusion therapy is recommended in patients with high-risk PE, while in intermediate-risk PE is controversial but could be indicated in those patients with a higher risk of hemodynamic instability and death due to right ventricular failure. Currently, the recommended reperfusion strategy in this group of patients is systemic thrombolysis. Catheter directed therapy can also be considered with less clinical evidence.

Purpose
Determine the safety and efficacy of catheter directed therapy compared with systemic thrombolysis in patients with acute PE who required reperfusion therapy.

Methods
A single-center retrospective observational cohort study was carried out in patients who were admitted for PE in a University Hospital from 2008 to 2021. Patients with intermediate-high and high risk PE, according to ESC guidelines, who underwent reperfusion therapies based on an institutional clinical practice guideline were included. Reperfusion was recommended in high-risk patients and those with intermediate-high risk who presented right ventricular dilatation associated with at least two of the following: heart rate ≥ 100bpm, systolic blood pressure ≤100mmHg or lactic acid ≥2mmol / L. Patients with surgical thrombectomy were excluded. In-hospital outcomes and 30-day follow-up between both strategies were analyzed.

Results
Catheter directed therapy was performed in 66% and systemic thrombolysis in 34% of the population. The prevalence of hemodynamic instability was 28.1% and in-hospital mortality was 25%. Baseline characteristics of both populations were similar and there were no differences in the location of the thrombi between both groups.
In-hospital mortality and major bleeding rates between catheter directed therapy and systemic thrombolysis were similar between both strategies (27.2% vs. 23.8%) and (9.0% vs. 4.7%) respectively. Both treatment groups presented a significant reduction in right ventricular diameters after reperfusion. Only catheter directed therapy showed an improvement in right ventricular function and a reduction in pulmonary pressures.

Conclusion
In this population no differences were observed in terms of safety and efficacy between both reperfusion therapies. Both strategies significantly reduced right ventricular diameters after reperfusion but only catheter directed therapy improved right ventricular function and reduced pulmonary pressures after 30 days which could have implications in a lower incidence of chronic thromboembolic pulmonary hypertension.