bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical predictors of in-hospital mortality in patients admitted with acute heart failure in an intensive care department
Authors: Moura A , Reina-Couto M , Roncon De Albuquerque R , Paiva JA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure (HF) is one of the major contemporary clinical challenges. Its prognosis is worse in the presence of exacerbations that require intensive care. Data regarding predictors of short-term prognosis of critical acute heart failure (AHF) in the contemporary era is lacking.

Aims
To identify independent clinical predictors of in-hospital mortality in this subgroup of patients.

Methods
Retrospective study of patients admitted at an ICU with the diagnosis of AHF between January and December of 2019 in a tertiary care hospital. Multivariable logistic regression analysis corrected for age, co-morbidities, clinical presentation severity and therapeutic measures was performed for in-hospital mortality.

Results
239 patients were included, predominantly men (60.7%), with a mean age of 69.5±14.8 years old. A high burden of cardiovascular risk factors was present and the majority didn’t have a previous known HF diagnosis (59.9%). Ischaemic disease was the most prevalent underlying cause (27.6%) and acute coronary syndrome was the most common trigger (35.6%). Mean ejection fraction was 37.5±16.9%. Mechanical circulatory support (MCS) was needed in 9.6% of the patients. Mean length of hospitalization was 5.6±6.0 days and in-hospital mortality rate was 18.9% (n=44). Cardiogenic shock unresponsive to the therapeutic measures (54.5%) and septic shock (20.5%) were the main causes of death. In-hospital mortality was higher in male patients (75.0% vs. 25.0%; p=0.03), who presented with sudden cardiac arrest (SCA) and cardiogenic shock (p&lt;0.001); who required MCS (p&lt;0.001) and evolved with a nosocomial infection (p=0.006); it was positively correlated with SAPS II score (p&lt;0.001) and negatively correlated with LVEF (p=0.002). In a multivariable logistic regression analysis MCS, older age and SCA at presentation were the only parameters with significant correlation with this outcome.

Conclusions
In the face of the need to manage limited resources, aspect that acquires more relevance in an intensive care scenario, identification of mortality predictors in critical AHF is relevant in order to develop risk scoring systems that allow to adequately select patients with a higher probability of survival. In our registry, age and severity of clinical presentation in terms of hemodynamic impact were the most robust variables to predict in-hospital mortality, more than previous known co-morbidities. Specifically, it draws attention to the need of careful analysis in larger studies of the subgroup of patients with SCA at admission to identify those in which intensive care measures will be superfluous to apply. It also highlights the relevance of taking measures to prevent nosocomial infection that assumes an important role in the mortality of these patients.
Relation of neutrophil gelatinase-associated lipocalin (NGAL) levels and in-hospital outcomes of ST-segment elevation myocardial infarction patients
Authors: Zahler D , Rozenfeld KL , Shtark M , Goldiner I , Lupu L , Banai S , Shacham Y 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Neutrophil gelatinase-associated lipocalin (NGAL) is a sensitive maker of both clinical and subclinical acute kidney injury (AKI). This glycoprotein is also stored in granules of mature neutrophils and is significantly increased in patients with myocardial infarction compared with patients with stable coronary artery disease or healthy subjects. Only limited data is present however, regarding the prognostic implications of NGAL in myocardial infraction patients.

Purpose
We evaluated the possible relation between NGAL levels and in-hospital outcomes in ST elevation myocardial infarction (STEMI) patients.

Methods
We included 267 patients with STEMI treated with primary coronary intervention. Blood samples for plasma NGAL were collected 24 hours following PCI. We assessed the relation of high serum NGAL, defined as values within the upper tertile (&gt; 66th percentile) and various parameters including left ventricular ejection fraction, AKI, In-hospital adverse events (heart failure symptoms, need for inotropes or 30-day mortality) as well as 30-day mortality alone.

Results
Patients having high NGALs levels (n=89) were more likely to have LVEF &lt; 45% (40% vs. 25%, p=0.009), AKI (43% vs. 4.5%, P&lt;0.001), a composite of in-hospital adverse outcomes (58% vs. 39%, p=0.003) and 30-day mortality (4.5% vs. 0.6%, p=0.04). High NGAL levels were also associated with longer hospital stay and C-reactive protein levels. In a multivariate regression model high NGAL levels were independently associated with in-hospital adverse outcomes (OR 2.03, 95%CI: 1.19 - 3.46, p=0.009).

Conclusions
Elevated NGAL levels suggesting increased inflammation are common among STEMI patients and may be a marker of adverse outcomes.
Survival and factors associated with survival with extracorporeal life support during cardiac arrest: a systematic review and meta-analysis
Authors: Panagides V , Laine M , Fond G , Lebreton G , Paganelli F , Michelet P , Roch A , Boyer L , Bonello L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Survival after sudden cardiac arrest (CA) remains low at approximately 10% despite recent advances in cardiopulmonary resuscitation (CPR). Extracorporeal life support (ECLS) may be useful to improve outcomes. However, it is resource intensive and associated with significant complications. We therefore performed a meta-analysis of all available observational studies of patients receiving ECLS-facilitated CPR to estimate the overall survival rate to discharge and predictors of survival.

Methods
We conducted a literature search in MEDLINE, PubMed EMBASE and the Cochrane Library from inception to September 2020. Studies were included if they focused on ECLS during CPR for CA in adult patients and provided survival data.

Results
Among the 1745 articles identified by our search, 81 studies involving 9256 patients were included in the analysis. Overall, the pooled estimated survival was 26.2% at discharge and 20.4% with a good neurological outcome. The heterogeneity across studies was significant for both outcomes. Meta-regressions found a significant association between survival at discharge and lower lactate values (b=-0.1, 95% CI [-0.2; -0.05], p=0.002), intrahospital CA (b= 0.005, 95% CI [0.002; 0.008], p= 0.002), and lower CPR duration (b=-0.009, 95% CI [-0.02; -0.002], p=0.02). After adjustment for age, intrahospital CA, and mean CPR duration, an initial shockable rhythm was the only independent factor associated with survival to discharge (b=0.02, 95% CI [0.007; 0.02], p=0.0004).

Conclusion
The overall survival rate on discharge of ECLS-facilitated CPR for CA was 26.2%, and the survival with good neurological outcome was 20.4%. An initial shockable rhythm was the only independent predictor of survival to discharge.
A novel method of approximating pressure-volume loops in the cardiac intensive care unit
Authors: Papolos A , Kenigsberg B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac pressure-volume relationship analysis is the gold standard method of describing cardiac mechanics. A number of methods for generating pressure-volume loops have been described; however, none can be easily applied to standard clinical practice in the cardiac intensive care unit (CICU). The ability to define the pressure-volume relationship and monitor response to treatment in patients with cardiogenic shock could aid in therapeutic selection.

Purpose
Our aim was to develop a method for modeling pressure-volume loops in the CICU using readily available data.

Methods
The cardiac pressure-volume relationship was derived using echocardiography to obtain ventricular volumes in conjunction with radial and pulmonary artery waveform analysis to determine ventricular pressures. The left ventricular end-diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) were determined via the biplane method of disks. A visual representation of pressure-volume data acquisition is presented in Figure 1. The end-diastolic pressure-volume intercepts were defined using the pulmonary capillary wedge pressure and the LVEDV (point 1). The end-isovolumic contraction pressure-volume intercepts were defined as the diastolic blood pressure and the LVEDV (point 2). The intercepts for peak ejection were defined as the systolic blood pressure and the LV volume at which half of the stroke volume was ejected (LVEDV + LVESV / 2) (point 3). The end-systolic pressure-volume intercepts were defined as the arterial dichrotic notch pressure and the LVESV (point 4). The end-isovolumic relaxation pressure-volume intercepts were defined as half of the pulmonary capillary wedge pressure and the LVESV (point 5). Each of the five points were connected by a line to create the pressure-volume loop. All invasive measurements were obtained at end-expiration by standard convention. A pressure-volume loop was then generated using the above model in a patient in cardiogenic shock on VA-ECMO.

Results
In vivo pressure-volume loop modeling of a patient in cardiogenic shock on VA-ECMO is presented in Figure 2.

Conclusions
Here we report a proof of concept for a novel method of approximating pressure-volume loops in the CICU using echocardiography and arterial waveform analysis data that is commonly available in patients with cardiogenic shock. While further validation is required, this method of pressure-volume analysis could be used for clinical and research purposes in the CICU.
Arrhythmia-induced cardiomyopathy: unveiled after electrical cardioversion
Authors: Menezes Fernandes R , Mota T , Costa H , Espirito Santo M , Bento D , Candeias R , Mimoso J , Jesus I 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Arrhythmia-induced cardiomyopathy (AIC) is an important cause of left ventricular (LV) dysfunction, confirmed by the reversal of cardiomyopathy after controlling the arrhythmia. It requires a high index of suspicion.

Purpose
To determine the prevalence and prognosis of AIC in patients referred to electrical cardioversion (EC) due to atrial fibrillation (AF) or atrial flutter (AFL).

Methods
We conducted a retrospective study encompassing patients referred to EC due to AF/AFL in our Cardiology Department, from September 2011 to September 2020. Clinical characteristics, echocardiographic studies and follow-up data were analysed. Reduced LV ejection fraction (LVEF) was defined as LVEF lower than 50%. Primary endpoints were all-cause mortality and cardiovascular (CV) death. We excluded patients with no information regarding LVEF before and after the EC.

Results
A total of 719 patients were referred to EC during the 9-year period, with a median age of 67 years-old and 70,4% male predominance. EC was successfully performed in 93,2%. Regarding patients with available LVEF data, only 123 patients (28,9%) had reduced LVEF before EC. Of these, 24,4% of patients were diagnosed with AFL, 59,3% had arterial hypertension, 26,9% were obese, 24,4% had ischemic heart disease and 7,3% had sleep apnea. Persistent AF/AFL was identified in 60,3%, 23,1% presented with first diagnosed AF/AFL and 15,7% had paroxysmal episodes. 57 patients (46,3%) had documented reversal of LV dysfunction after EC (improvement of a median LVEF of 41% to 59% after EC), confirming AIC diagnosis. Comparing to patients who did not recover LV function after EC, AIC patients had a larger prevalence of persistent AF/AFL (75% vs 45,2%; p=0,01), were more frequently cardioverted in an outpatient setting (68,4% vs 46%; p=0,047) and had lower prevalence of ischemic heart disease (5,3% vs 42,9%; p&lt;0,001) and stroke (1,8% vs 12,7%; p=0,023). They also had lower values of CHA2DS2-VASc (2,23 vs 3,19; p&lt;0,001) and HAS-BLED scores (0,6 vs 1,03; p=0,005) scores and were more treated with direct oral anticoagulants (77,8% vs 54,5%; p=0,01) than vitamin K antagonists. 64,6% remained in sinus rhythm one year after EC (vs 42,6%; p=0,026). During a median follow-up of 1338 days, no significant differences were found regarding all-cause mortality, but we report a lower rate of CV death in AIC patients (3,8% vs 25,5%; p=0,002).

Conclusion
In our study, 46,3% of patients with reduced LVEF had AIC, which was associated with a significantly lower rate of CV death. Given the prognostic impact of this diagnosis, EC should be considered as a primary strategy in patients with high suspicion of AIC due to AF/AFL.
Short term impact of COVID-19 pneumonia in patients with reduced left ventricular ejection fraction (LVEF)
Authors: Thangasami S , Prajapati J , Sahoo S , Mishra A , Singh G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The coronavirus disease 2019 (COVID-19) is mainly a respiratory disease potentially leading to acute respiratory distress syndrome but can have multiple system involvement. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance.

Purpose
To describe the short-term impact of COVID-19 pneumonia in patients with reduced Left ventricular ejection fraction (LVEF).

Methods
This single center, prospective observational study included 141 RT-PCR confirmed COVID-19 patients who had reduced ejection fraction on echocardiography quantitively assessed by modified Simpson’s method. The study group were divided into three groups based on the ejection fraction: 34 patients had mild left ventricular (LV) dysfunction (LVEF&gt;41-50%), 50 patients had moderate left ventricular dysfunction (LVEF=31-40%) and 57 patients had severe left ventricular dysfunction (LVEF &lt;30%). Demographics, clinical characteristics, in hospital events and clinical sequelae of survivors during 6 months follow up period were analyzed.

Results
Mean age of the study population was 60.22± 12.53 years.71.6% were males and 28.3% were females. Average length of hospital stay in the study group was 10.93±6.9 days. Patients with mild LV dysfunction had longer hospital stay (13.65± 7.09 days) than patients with moderate LV dysfunction (10.90±6.05 days) and patients with severe LV dysfunction (9.33±6.83 days) (p=0.01). Patients with severe LV dysfunction had higher Interleukin-6 levels (IL-6) and BNP levels in comparison to other groups.50% of patients with severe LV dysfunction required invasive ventilation during the course of hospital stay, while it was 20.6% in patients with mild LV dysfunction and 32% in patients with moderate LV dysfunction. 63% of patients with severe left ventricular dysfunction expired in the study period compared to 26.4% of patients with mild LV dysfunction and 40% of patients with moderate LV dysfunction (P=0.001). Patients with severe LV dysfunction had increased major adverse cardiac events in 6 months follow up compared to patients with mild and moderate LV dysfunction. Patients with severe LV dysfunction had increased in hospital mortality (40%) compared to patients with mild LV dysfunction (20%) and patients with moderate LV dysfunction (32%). Patients with higher levels of IL-6 (OR: 1.004, 95% CI: 1.002-1.01, P&lt;0.001), procalcitonin (OR: 1.24, 95% CI: 1.07-1.44, P=0.004) and CT severity score (OR1.21, 95% CI: 1.13-1.28, P&lt;0.01) are independent predictors of mortality in the study population.

Conclusion
Patient with reduced ejection fraction (LVEF &lt;30%) have a poor 6 month outcome after COVID 19 pneumonia.
Relationship between quality of life indicators and clinical and instrumental indicators in NSTEMI patients
Authors: Maslovskyi VI , Ivanov VP , Mezhiievska IA 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Purpose
To determine the quality of life indicators and relationship with different clinical and instrumental parameters in NSTEMI patients.

Methods
We studied 200 patients with NSTEMI aged from 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Quality of life indicators were assessed by MIDAS-35. All of the research corresponds to the principles of the Declaration of Helsinki of the World Medical Association.

Results
In order to select the most informative model variables (independent predictors), a preliminary Spearman correlation analysis of the initial parameter (summary score for MIDAS-35) was performed with all clinical, instrumental and laboratory parameters that represented the statistical matrix of the study. There was a direct moderate correlation with the degree of stenosis of the LCx in % according to coronary angiography (R = 0.31, p &lt;0.0001) and the size of the LA in mm (R = 0.32, p &lt;0.0001) and weak - with the presence of frequent VE (R = 0.25, p = 0.001), the presence of paroxysms of the VT (R = 0.24, p = 0.002), smoking (R = 0.29, p = 0.0002), the level of total cholesterol &gt; 6 mmol / l (R = 0.17, p = 0.02) and ST2 in plasma (R = 0.18, p = 0.02). In addition, a negative weak correlation between the total score and the nature of LV diastolic dysfunction (R = -0.22, p = 0.001) and the presence of the biochemical association ST2 &lt; 36 ng / ml + Tp I &gt; 6 ng / ml in plasma ( R = -0.23, p = 0.003) (Tab. 1).

Conclusion
Our correlation analysis allowed us to identify the factors that have the greatest impact on the quality of life in patients with NSTEMI. It was found that the increase in the total score for MIDAS and the deterioration of quality of life depends on the type of coronary artery disease, ST2 level, total cholesterol and myocardial remodeling.
Mechanical ventilation in patients with cardiogenic shock complicating acute myocardial infarction
Authors: Povlsen AL , Helgestad OKL , Josiassen J , Christensen S , Hassager C , Schmidt H , Jensen LO , Holmvang L , Moeller JE , Ravn HB 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Invasive mechanical ventilation (IMV) provides up to a 30% reduction in cardiac output requirements and is frequently used in patients with cardiogenic shock following acute myocardial infarction (AMICS). However, practice of IMV in the setting of AMICS is sparsely described.

Purpose
The aim was to evaluate the use of IMV in a contemporary cohort of patients with AMICS.

Methods
Between 2010 and 2017, all adult AMICS patients admitted to two tertiary heart centres, providing AMICS care for two thirds of the Danish population, were individually identified through patient records. Temporal changes in application of IMV were registered as well as patient characteristics. Real-time electronic ICU data were available for a subset of mechanically ventilated ICU patients (n=566), and were retrieved for the first 24 hours of IMV, following ICU admission, and described in relation to 30-day survival and the presence of out-of-hospital cardiac arrest (OHCA).

Results
A total of 1716 AMICS patients were retrospectively identified, of which 1274 (74%) received IMV during ICU admission (IMV-ICU). The proportion of IMV increased from 70% in 2010 to 78% in 2017. IMV-ICU patients were younger (67 vs 76 years), more frequently male (79% vs 61%), and more likely to have OHCA (54% vs 3%) and higher lactate at diagnosis of cardiogenic shock (5.8 vs 4.1 mmol/L) compared with non-intubated patients (p for all&lt;0.001). Among IMV-ICU patients, 69% were intubated in the prehospital setting, of which three quarters presented with OHCA. Median PaO2 and PCO2 were both within normal ranges among 30-day survivors and non-survivors. However, non-survivors required 10-25% higher median fraction of inspired oxygen (p&lt;0.001; FiO2), positive-end-expiratory pressure (p=0.002; PEEP), and minute ventilation (p&lt;0.001; MV). Differences in IMV settings were mainly driven by non-survivors without OHCA (see table).

Conclusion
In a contemporary cohort of patients with AMICS, use of IMV increased during the observation period from 2010 to 2017. Observations did not reveal any association between 30-day mortality and IMV parameters in OHCA-patients, whereas FiO2, PEEP, and MV were significantly elevated in 30-day non-survivors without OHCA.
Neurological intact survival with rescue mechanical circulatory support for refractory out-of-hospital cardiac arrest despite long low-flow times
Authors: Moerk S , Christensen S , Boetker MT , Tang M , Terkelsen CJ 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The potential window for using mechanical circulatory support (MCS) for refractory out-of-hospital cardiac arrest (OHCA) remain unsettled. It has been proposed that a cut-off limit defined as the golden hour may produce higher survival with good neurological outcome.

Purpose
The present study analyzed the association of low-flow time and neurological intact survival (Cerebral Performance Categories 1-2) at discharge between patients receiving conventional cardiopulmonary resuscitation (CCPR) and MCS.

Methods
The present retrospective, observational, single centre study from 2015-2019 included all consecutive OHCA patients, who were treated with MCS for refractory OHCA or received CCPR. Low-flow time was defined as the time from CPR to deployment of either veno-arterial extracorporeal membrane oxygenation or Impella support for the MCS group. Time from CPR to return of spontaneous circulation or termination of treatment was recorded for the CCPR group. Rate of neurological intact survival at discharge were analyzed for both groups.

Results
A total of 101 patients were treated with MCS and 914 patients received CCPR. The MCS group was significantly younger with a median age of 56 (IQR, 46-62) years compared to 67 (IQR, 57-74) years, p &lt; 0.001. In the CCPR group, short low-flow times (0-20 minutes) were associated with high survival with good neurological outcome at discharge. There were no survivors with low-flow times exceeding 70 minutes. All patients receiving MCS survived at low-flow times 31-60 minutes, however neurological intact survival dropped to 21% at low-flow times &gt; 80 minutes.

Conclusion
Patients treated with MCS with low-flow time 70-80 minutes did show similar favorable neurological outcome at discharge as patients receiving CCPR with low-flow &lt; 10 minutes. Despite, low-flow times exceeding 80 minutes, patients treated with MCS still presented high survival rate of 21%. Hence, the data in this study does not support a golden hour for MCS.