bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of attention deficit/hyperactivity disorder (ADHD) in congenital heart diseases (CHD), a systematic review and meta-analysis
Authors: Tarek Hasan M , Shaban Abdelgalil M , A Elbadawy M , Mahmoud Elrosasy A , Elkhadragy A , K Awad A 
Published: October 2022

Abstract

Introduction
Neuropsychiatric disorders are well-established in patients with congenital heart defects (CHD); moreover, patients with CHD have higher three to four times risk for inattention and hyperactivity. Several published studies have investigated the prevalence of attention deficit/hyperactivity disorder (ADHD) among patients with CHD, thus we conducted our meta-analysis in an attempt to further investigate the role of CHD in increasing the incidence of ADHD.

Methods
Electronic databases were systematically searched to identify any observational or interventional studies that compared the effects of congenital heart disease on the incidence or progression of ADHD. Pooled mean difference (MD) and their 95% confidence intervals (CI) were calculated using inverse variance and fixed effect models

Results
We identified eight studies with 120187 patients with a mean age of 15.8 years. Patients with CHD compared to healthy population have statistically significant higher scores in ADHD inattention subscale, ADHD hyperactivity-impulsivity subscale, ADHD combined scale (Fig. 1) with MD of 0.25 [95% CI 0.13, 0.37, p&lt;0.0001], 0.16 [95% CI 0.04, 0.28, p=0.008], 0.23 [95% CI 0.11, 0.35, p=0.0002], respectively. Furthermore, ADHD index T score (Fig. 2) for both self-reported and informant report showed a statistically significant increase in CHD with MD of 0.42 [95% CI 0.26, 0.58, p&lt;0.00001] and 0.86 [95% CI 0.52, 1.19, p&lt;0.00001].

Conclusion
CHD showed an associated increased risk for the development of ADHD which was confirmed with several ADHD scales.

Funding Acknowledgement
Type of funding sources: None.
Genetic background of pediatric PAH in Spain and its clinical implications: data from the REHIPED Spanish Registry
Authors: Cruz Utrilla A , Gallego N , Tenorio-Castano J , Guillen I , Torrent-Vernetta A , Moya A , Labrandero C , Garrido-Lestache E , Moreno A , Escribano-Subias P , Del Cerro M J 
Published: October 2022

Abstract

Background
The genetic background of pulmonary arterial hypertension (PAH) in the Spanish pediatric population could be different from the genetic background described in other countries. Besides, clinical implications of a positive genetic result in the PAH pediatric population are not fully understood yet, and could result in the “reclassification” of patients from one PAH group to another type among the current pediatric classification.

Material and methods
Patients under 19 years at diagnosis included in the REHIPED registry from January 2011 to December 2021 were included. Clinical variables and genetical results were recorded. Succesive NGS panels involving up to 35 genes were used. After the results of the genetic testing, we analyzed differences in survival, and if patients “moved” to another category in the current Nice classification.

Results
In the selected cohort of 98 patients (56.1% female), median age at diagnosis was 7.1 years (IQr 1.5–14.7), and ethnicity as follows: Caucasian (81.6%), Romani (8.2%), others (10.2%) (Table 1). Before the genetic testing, patients had been classified as Idiopathic (53.1%), Congenital Heart Disease-PAH (30.6%), Heritable (5.1%), Pulmonary veno-oclusive disease (PVOD) 6.1%, and Multisystemic disorder associated with PAH (5.1%). Pathogenic or likely pathogenic variants were found in 44 of the screened patients (44.9%): BMPR2 (12 cases), EIF2AK4 (9), TBX4 (n=4), MECP2 (n=3), KCNK3 (n=2), FOXF1 (n=2), NFU1 (N=4), ACVRL1 (n=1), BMPR1B (n=1), CLBCI (n=1), GBE1 (n=1), GDF2 (n=1), SOX17 (n=1), VHL (n=1), and digenic pathogenic variant in ABCC8/SMAD1 (n=1). After genetic analysis, 28 patients (28.6%) were “reclassified” (Fig. 1, panel A), with HPAH, PVOD and multisystemic disorders increasing up to 18.4%, 8.2%, and 12.2%, respectively. Worse Survival from death or lung transplantation was observed in heritable PVOD and multisystemic disorders (Fig. 1, panel B).

Conclusions
The Spanish pediatric PAH population showed higher prevalence of EIF2AK4 than other pediatric registries. Genetic testing resulted in the “reclassification” of a significant number of patients.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Rio Hortega grant from the Spanish Ministry of Science and Innovation (Instituto de Salud Carlos III).
Cardiac arrest on persons under the age of 20, from 1996 to 2019
Authors: Andrade T M A , Marques M L C , Guerra S A G , Salim T R , Oliveira G M M 
Published: October 2022

Abstract

Introduction
Cardiopulmonary arrest (CPA), in pediatrics, has high mortality and severe neurological sequelae. Information on the causes and mechanisms of death in children under 20 can provide theoretical support for improving health in childhood and adolescence.

Objectives
To carry out a population analysis of mortality rates (MR) from basic and multiple causes of death, in children under 20 years of age, of both sexes, from 1996 to 2019, and to identify the frequency of description of CPA in death certificates (DC) of these individuals and their places of occurrence, to promote strategies to improve the prevention of deaths.

Method
An ecological time-series study, from 1996 to 2019, of children deaths under 20 years of age, in which MR and we evaluated proportional mortality (PM) due to underlying cause of death. We analyzed the percentage of CPA description in the DC (any lines) and the place of occurrence. Also, we described MR per 100,000 inhabitants and PM due to underlying cause of death under 20 years of age, by sex, and age group. The percentages of death from underlying causes were calculated when CRP was described in any line of parts I and II of the DC, by age groups, and the percentages of death from underlying causes, according to their place of occurrence.

Results
In Brazil, from 1996 to 2019, there were 2,151,716 deaths in children under 20 years of age, with a TxM of 134.38 per 100,000 inhabitants, with higher death rates among male neonates. Two hundred forty-nine thousand three hundred thirty-four had CPA described in any DC line, corresponding to 11.6% of these deaths. We defined four patterns for the underlying cause of death when CPA in the death sequence. In the neonatal period, perinatal causes; in children under five years, respiratory system diseases; 5 to 14 years, neoplastic and hematological; and in adolescents aged 15 to 19, external causes. The central place of occurrence of these deaths was in the hospital.

Conclusion
The highest MR of underlying causes of death, in those under 20 years of age, in Brazil, from 1996 to 2019, was due to perinatal and external causes. When we evaluated multiple causes of death, the leading underlying causes of CPA were respiratory, hematological, and neoplastic diseases, with higher in-hospital mortality. It is crucial to understand deaths sequence events and implement teaching strategies to pediatric cardiopulmonary resuscitation.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): CAPES
Cardiac findings in multisystem inflammatory syndrome in children (MIS-C) – single institution experience
Authors: Smajlovic E , Grahic-Mujcinovic O 
Published: October 2022

Abstract

Background
Multisystem inflammatory syndrome in children (MIS-C), associated with coronavirus disease 2019 (COVID-19) is a rare but serious condition, affecting children mostly after acute SARS CoV2 infection. MIS-C presents with fever, laboratory evidence of inflammation, and multiorgan dysfunction, including heart.

Purpose
We analized the degree of cardiac involvement and clinical outcomes of MIS-C patients hospitalized in Pediatric department of Cantonal hospital Zenica, to compare with previously reported findings.

Methods
Cardiac testing results in pediatric patients hospitalized with MIS-C from November 2020. until March 2022. were retrospectively analized. For this study, MIS-C patients with positive cardiac testing were defined as having an abnormality of one or more of the following on admission: cardiac biomarkers, electrocardiogram, and/or echocardiogram.

Results
Cardiac abnormal findings were present in almost all of our ten patients with MIS-C, but the extent of cardial injury was lower than we expected it to be. Abnormal EKG was found in 80% patients with the most common electrocardiography findings: low voltage (50%) and T wave abnormality (70%). Echocardiography abnormalities were present in 80% patients mostly including valvular regurgitation (mitral, pulmonal), and rarely pericardial effusion or left ventricular diastolic disfunction (20%). Elevated cardiac biomarkers were seen in 70% patients. By the time of hospital discharge or short time follow-up all cardiological findings were diminished. Six months follow-up found no cardiac sequellae and 24h electrocardiogram with heart rate variability parametres found no disturbancies outside physiological or underlying chronic disease.

Conclusion
While most patients in our study had evidence of abnormal cardiac testing on hospital admission, all cardiac findings were normal by hospital discharge. Cardiologic findings were representative for subacute myocardial injury with good clinical outcome and no sequellae. The degree of cardiac involvement was mild compared with previous reports.

Funding Acknowledgement
Type of funding sources: None.
Long term outcomes in different aetiologies of perioperative myocardial infarction/injury after noncardiac surgery
Authors: Puelacher C , Gualandro D , Glarner N , Lurati Buse G , Lampart A , Bolliger D , Grossenbacher M , Steiner L , Burri K , Biner L , Caramelli B , Cardozo F A , Osswald S , Mueller C 
Published: October 2022

Abstract

Background
Perioperative myocardial infarction/injury (PMI) occurring in the first 48h following noncardiac surgery is a frequent cardiac complication. Better understanding of the underlying aetiologies is urgently needed.

Aim
To explore the association of different aetiologies of PMI with long term outcomes.

Methods
In this prospective multicenter observational study, PMI aetiology was centrally adjudicated and hierarchically classified by two independent physicians based on all information obtained during clinically-indicated PMI work-up including cardiac imaging among consecutive high-risk patients undergoing major noncardiac surgery. PMI aetiology was classified into “extracardiac” if caused by a primarily extracardiac disease such as severe sepsis or pulmonary embolism; and “cardiac”, further subtyped into type 1 myocardial infarction (T1MI), tachyarrhythmia, acute heart failure (AHF), or likely type 2 myocardial infarction (lT2MI). Major adverse cardiac events (MACE) including T1MI, AHF (both only from day 3 to avoid inclusion bias), life-threatening arrhythmia, and cardiovascular death as well as all-cause death were assessed during 365-days follow-up.

Results
PMI occurred in 1016/7754 patients (13.1%). At least one MACE occurred in 684/7754 patients (8.8%) and 818/7754 patients died (10.5%) within 365 days. MACE and all-cause death occurred in 51% (95% CI 31–60) and 38% (95% CI 29–47), 41% (95% CI 28–51) and 27% (95% CI 16–34), 57% (95% CI 41–69) and 40% (95% CI 25–53), 64% (95% CI 45–76) and 49% (95% CI 30–62), as well as 25% (95% CI 22–28%) and 17% (95% CI 14–20) of patients with extracardiac PMI, T1MI, tachyarrhythmia, AHF, and lT2MI, respectively. These associations were confirmed in multivariable analysis.

Conclusion
At 365 days, most PMI aetiologies have unacceptably high rates of MACE and all-cause death, highlighting the urgent need for more intensive treatments.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationRoche Diagnostics
Performance of Society of Thoracic Surgeons and EuroSCORE II pre-surgical mortality risk score for cardiac surgery in a large majority-minority population
Authors: Seto B K , Tsai P , Seto T B 
Published: October 2022

Abstract

Background
Pre-surgical mortality risk scores are important tools for pre-operative assessment. The Society of Thoracic Surgeons (STS) and EuroSCORE II (ES) scores were derived from predominantly white populations; their utility in minority populations is understudied.

Purpose
To compare the performance of STS and ES in a large majority-majority population.

Methods
We used cardiac surgery registry data from a tertiary care, 500-bed, university-affiliated hospital. For each patient, STS and ES risk of mortality were calculated. We measured model performance by discrimination (ROC-AUC) and calibration (O/E ratios). We compared performance by racial subgroups, and explored differences in risk stratification by race and risk category by measuring risk reclassification if ES were used instead of STS.

Results
From 2009–20, 4061 patients underwent CABG (68%), valve (18%), or CABG/valve (7%) surgery. Of these, 51% were Asian (n=2076), 24% Native Hawaiian and other Pacific Islander (NHPI) (n=977), 23% White (n=919) and 3% Other (n=79). Overall, STS underestimated (O/E: 1.09) and ES overestimated (O/E: 0.55) mortality risk. STS had better discrimination (ROC-AUC: 0.83 vs 0.77). STS model calibration was better among Asians (O/E: 1.03) than NHPI (O/E: 1.22) and Whites (O/E: 1.14). ES calibration was poor overall (Asian O/E: 0.58, NHPI O/E: 0.54, White O/E: 0.50). Discrimination was similar in STS (Asian AUC: 0.83, NHPI AUC: 0.85, White AUC: 0.86) and ES (Asian AUC: 0.77, NHPI AUC: 0.77, White AUC: 0.81), although it did perform better for White patients. Of patients defined as Low Risk by STS, 31% were reclassified as Intermediate or High Risk by ES. Of patients defined as High Risk by STS, 27% were downgraded to Intermediate or Low Risk by ES. This differed by race. For Asians, 28% at Low Risk and 31% at High Risk by STS were reclassified when using ES. For NHPI, 36% at Low Risk and 22% of High Risk by STS were reclassified by ES. For Whites, 31% at Low Risk and 19% of High Risk by STS were reclassified by ES.

Conclusion
The choice of pre-surgical risk score can impact estimates of pre-cardiac surgery risk of mortality. While STS performs better than ES in our majority minority population, there are significant differences by race.

Funding Acknowledgement
Type of funding sources: None.
Sacubitril valsartan in aged patients with heart failure and reduced ejection fraction: a safe and beneficial therapy
Authors: Romero Otero J M , Cortes Garcia M , Rodriguez Lopez C , Balaguer German J , Esteban Chapel J A , Nieto Roca L , Martinez Milla J , Taibo Urquia M , Pello Lazaro A M , Tunon Fernandez J 
Published: October 2022

Abstract

Background
Heart failure (HF) constitutes a prevalent diagnosis in aged patients. During the last decades, several therapies have demonstrated clinical benefits among patients with HF and left ventricular systolic disfunction (LVSD), including novel angiotensin receptor-neprylisin inhibitors (ARNI). Nevertheless, these findings remain unclear in the elderly.

Purpose
The objective of this study is the evaluation of ARNI treatment in aged patients with HF and reduced left ventricular ejection fraction (LVEF)..

Methods
Patients were prospectively recruited from January 2016 to December 2020. Subjects LVSD (defined by LVEF below 40%), aged ≥75 years and indication for ARNI were included. Clinical, electrocardiographic and echocardiographic variables were collected.

Results
A total of 616 patients were included in the present study. Median age was 83.3 years old (standard deviation, SD, ± 5.1) and 65.6% were male. 81.2% had hypertension, 35.4% diabetes, and 57.1% dyslipemia. Chronic kidney disease was present in up to 53.6% of the patients; 17.8% suffered from chronic lung disease and 16.2% from cerebrovascular disease. At baseline, the mean LVEF was 29.3% (SD ± 7.7%), being the ischemic disease the most common etiology, with 46.6% of the cases. 60.0% of the patients had sinus rhythm on ECG at inclusion. Nearly 45.0% of the patients had been hospitalized before the recruitment due to heart failure. 77% of the patients had BB in their treatment; 55% had ACEIs / ARBs; 40% had MRA; 4% had iSGLT2. The percentage of patients with ARNI was 14.3%. The median follow-up was 35 months; in this time, 50.2% died; cardiovascular events (dead for any cause or new admission secondary to heart failure) were reported in 62.2% of the patients. A multivariate survival study was performed, using Cox regression. It showed that the use of ARNI in this population represent a powerful protective factor against mortality (HR 0.268; 95% CI 0.162–0.443).

Conclusion
In our study, it has been shown that ARNI improved survival in aged subjects with HF and LVSD. However, this drug is underuse in this population. This may be related to frailty, greater comorbidity and the polypharmacy that lead to lesser accomplishment of clinical guidelines recommendations. However, it would be recommendable to confirm our findings with further studies.

Funding Acknowledgement
Type of funding sources: None.
Trans-catheter mitral valve repair in the elderly and very elderly patients with focus on postprocedural safety and 1-year effectiveness
Authors: Mahnkopf C , Schnupp S , Amami M , Mady H , Salloum B , Ajmi I 
Published: October 2022

Abstract

Background and objectives
Symptomatic mitral regurgitation (MR) is associated with a high mortality rate and high heart failure-related hospitalization. Symptomatic therapy in the elderly and very elderly patients remains weak in controlling severe MR with an elevated morbidity and mortality rate. Patients with an increased risk of surgical repair of the MR seemed to benefit from MitraClip procedures. Therefore, we thought to analyze the postprocedural safety and success of the MitraClip in octogenarians and older patients.

Methods
Elderly and very elderly patients with severe and symptomatic MR were presented and evaluated in the heart team. Patients with high surgical risks underwent MitraClip (Abbot, USA) procedure in our center. Post-procedural transthoracic echocardiography (TTE) procedure was performed to determine the MR grade and exclude procedure-related complications.

Results
Two hundred eleven consecutive patients, older than 80 years (83.75±2.95, 106 Men (83.5±3.06) and 105 Women (84.01±2.83)), who received MitraClip between May 2015 and May 2020 were enrolled. The baseline characteristics are presented in table 1. Procedural success, defined as reducing the MR to grad I-II, was achieved in 93% of the patients (3.11±0.34 vs. 1.25±0.46, P=0.002). All patients improved in the New York Heart Association functional class (3.04±0.40 vs. 1.92±0.76) one year after the intervention. No procedure-related death was registered. 81% (n=168) survival rate was achieved one year after the intervention. No clip embolization was detected in 3 months echocardiography control, Table 2.

Conclusions
Our preliminary results indicate that MitraClip is a safe and effective therapeutic option in elderly and very elderly patients with severe MR and high surgical risks. Therefore, this therapy should be considered despite age and comorbidities for effective symptomatic treatment in this particular cohort.

Funding Acknowledgement
Type of funding sources: None.
Impact of dementia and drug compliance on patients with acute myocardial infarction
Authors: Lee W , Kang S H , Kim S H , Chae I H 
Published: October 2022

Abstract

Background
There has been a worrying rise in the number of people with dementia, especially with many of them also suffering from acute myocardial infarction (AMI), a disease with a high mortality rate.

Purpose
We evaluated the impact of dementia on the mortality of patients with AMI and how drug compliance affects this relationship.

Methods
The data were derived from National Health Insurance Service-Senior. The total number of patients diagnosed with AMI for the first time between 2007 and 2013 was 16,835, among whom 2,021 had dementia. Medication possession ratio (MPR) was used to assess medication adherence.

Results
AMI patients with dementia had unfavorable baseline characteristics; they had significantly higher risk of all-cause mortality (Hazard ratio [HR]: 2.49; 95% confidence interval (CI): 2.34–2.66; P&lt;0.001) and lower MPR (aspirin: 21.9% vs. 42.8%; P&lt;0.001). AMI patients were stratified by presence of dementia and medication adherence, and the survival rate was the highest among those with no dementia and good adherence. followed by those with no dementia and poor adherence, those with dementia and good adherence, and those with dementia and poor adherence. The multivariable analysis revealed that dementia (HR: 1.64; 95% CI: 1.53–1.75; P&lt;0.001) and poor adherence to medication (HR: 1.60; 95% CI: 1.49–1.71; P&lt;0.001) had a significant association with all-cause mortality in AMI patients.

Conclusions
AMI patients with dementia have a higher mortality rate. Patients with dementia have poorer medication adherence than those without, negatively affecting their prognosis.

Funding Acknowledgement
Type of funding sources: None.
Efficacy of cryoballoon ablation for atrial fibrillation in a geriatric population
Authors: Boehmer A A , Rothe M , Nussbaum E , Zezyk C , Dobre B C , Kaess B , Ehrlich J R 
Published: October 2022

Abstract

Background
Cryoballoon pulmonary vein isolation (cryoPVI) is well-established for paroxysmal atrial fibrillation (AF) but its value in persistent AF is less clear. In particular, its efficacy in cardiogeriatric patients (≥75 years) is unknown. Age represents an important modifier of AF progression and is a risk-factor for AF recurrence.

Methods
We conducted a prospective, single-center study to analyze efficacy and safety of cryoPVI in cardiogeriatric patients stratified according to AF entity. Maximum follow-up was 24 months. Efficacy endpoint was symptomatic AF relapse after 90-day blanking period.

Results
We included 668 patients. Of these 218 were ≥75 years old. Paroxysmal AF was present in 400 and persistent AF in 268 patients. By means of cox-regression analysis we found age as the only independent factor influencing AF recurrence in the overall cohort (P=0.034). This effect was carried by patients with persistent AF (P=0.006). At 24 months, the recurrence rate was highest in patients with persistent AF and age ≥75 years (57%; P=0.0004).

Conclusion
Cardiogeriatric patients with persistent AF undergoing cryoPVI had higher rates of AF recurrence compared to elderly patients with paroxysmal AF or younger patients. Against this background we assume, that pulmonary-vein dependent AF may be less frequently encountered among patients ≥75 years with persistent AF.

Funding Acknowledgement
Type of funding sources: None.