bluuebunny/crossref_metadata_2025_split huggingface dataset:
Bystander interventions in out-of-hospital cardiac arrest according to geographical area type
Authors: Christensen N , Folke F , Juul Joergensen A , Kollander Jakobsen L , Samsoee Kjoelbye J , Andelius L , Tofte Gregers M , Bundgaard Ringgren K , Torp-Pedersen C , Malta Hansen C 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): TrygFonden

Introduction
Bystander interventions and survival after out-of-hospital cardiac arrest (OHCA) have increased remarkably in Denmark over the last years. Even though 75% of all OHCA occur in residential areas, most interventions to increase bystander interventions have focused on public places. This study assessed bystander interventions (cardiopulmonary resuscitation [CPR] and defibrillation) according to area type.

Methods
We included bystander witnessed OHCAs from the Danish Cardiac Arrest Registry (2016-2019) with a known geographical location. Urban Atlas is an international data base covering 40% of Denmark, which uses satellite images to divide areas into different area types. In this study, Urban Atlas was used to identify and geocode OHCAs within the following subgroups: high density residential areas (defined as average degree of soil sealing &gt;50%), low density residential areas (average degree of soil sealing &lt;50%), public and industrial sites, nature, sport and leisure facilities, transportation (e.g. airport and railway stations), and fast transit roads.

Results
A total of 5,180 bystander witnessed OHCA were covered by Urban Atlas and included. The proportion of bystander interventions was lowest in residential areas where most OHCAs occurred (Figure 1). The proportion of bystander interventions was highest in sport and leisure areas and transportation sites. The proportion of bystander defibrillation increased 5-fold in transportation sites and 3-fold in sports and leisure sites compared with residential areas.

Conclusion
Patients with OHCA in transportation areas and sports and leisure areas were substantially more likely to receive bystander CPR and defibrillation, highlighting the success of initiatives to increase bystander interventions in public areas. Bystander defibrillation was lowest in residential areas supporting further efforts, such as smartphone activated volunteer responder activation, to improve bystander defibrillation in residential areas.
Mortality risk in cardiogenic shock: Head to head comparison CardShock vs IABP score depending on aetiology, the Shock CAT study
Authors: Garcia-Garcia C , Lopez T , Sanz E , Sanchez-Salado JC , Aboal J , Tomas C , Baneras J , Sionis A , Andrea R , Perez-Rodriguez M , Ruiz M , Pastor P , Buera I , Cediel G , Rueda F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Mortality in cardiogenic shock (CS) remains very high. Several risk scores have been purposed to early stratification. The aetiology of CS could influence in the usefulness of different risk scores.

Purpose
The aim is to investigate in-hospital prognosis and mortality risk in CS patients comparing the prognostic accuracy of CardShock and IABP scores in a Mediterranean cohort depending on the CS aetiology.

Method
Shock CAT study was a multicentre, prospective, observational study conducted between December 2018 and December 2019 in eight public University hospitals in Catalonia (Spain), including CS patients due to acute coronary syndrome (ACS) and other aetiologies. Data on clinical presentation, biomarkers, management, including mechanical assistance support were analyzed. Cardshock and IABP score have been compared to assess 90-days mortality risk in a Mediterranean cohort.

Results
A total of 382 CS patients were included, mean age was 65.3 (SD 13.9) years and 75.1% were men. The most common cause of CS was ACS (61%, n=233); of them, 77.6% were STEMI, 9% developed mechanical complications and 19.4% primary ventricular fibrillation. STEMI patients were reperfused in 84.7% of cases, all with primary angioplasty. Main non-ACS aetiologies were severe acute heart failure, malignant arrhythmias and myocarditis. Mechanical assistance device was implanted in one third of patients (n=119), mainly intraaortic balloon pump (26.1%), ECMO in 7.8% and Impella CP in 4.5%. Average Cardshock score was 4.3 (SD 1.74) and mean IABP score was 2.2 (SD 1.61). In-hospital mortality was 33% (126 patients) and 90-days mortality was 37.3% (141 patients). Receiver-operating characteristic (ROC) curves demonstrated that IABP shock score had superior prognostic power for predicting 90-days mortality when compared with Cardshock score (area under the curve 0.72 vs 0.66) respectively, p=0.042; Figure 1. Although this superiority only was reached in ACS patients (area under the curve -AUC- 0.74 vs 0.66) respectively, p=0.047; because both scores were similar in non-ACS (AUC 0.64 vs 0.62, p=0.693), Figure 2.

Conclusions
Even though invasive management with STEMI reperfusion and mechanical assistance devices, cardiogenic shock in-hospital mortality remains 33% in a contemporary Mediterranean cohort. In this population, IABP shock score provided better 90-days mortality risk prediction than CardShock score, mainly in CS sue to ACS.
Soluble neprilysin and survival in critically ill patients
Authors: Lenz M , Krychtiuk KA , Brekalo M , Draxler DF , Pavo N , Hengstenberg C , Huber K , Huelsmann M , Heinz G , Wojta J , Speidl WS 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Critically ill patients admitted to an intensive care unit (ICU) exhibit a high mortality rate irrespective of the initial cause of hospitalization. Neprilysin, a neutral endopeptidase degrading an array of vasoactive peptides became a drug target within the treatment of heart failure with reduced ejection fraction.The aim of this study was to analyze whether circulating levels of neprilysin at ICU admission are associated with 30-day mortality.

Methods
In this single-center prospective observational study, 222 consecutive patients admitted to a tertiary ICU at a university hospital were included. Blood was drawn at admission and soluble neprilysin levels were measured using ELISA.

Results
In the total cohort, Soluble neprilysin levels did not differ according to survival status after 30 days as well as type of admission. However, in patients after surgery or heart valve intervention, 30-day survivors exhibited significantly lower circulating neprilysin levels as compared to those who died within 30 days (660.2, IQR: 156.4 – 2512.5 pg/ml versus 6532.6, IQR: 1840.1 – 10000.0 pg/ml; p=0.02). Soluble neprilysin predicted mortality independently from age, gender, and commonly used scores of risk-prediction (EuroSCORE II, STS-score, and SAPS II score). Additionally, soluble neprilysin was markedly elevated in patients with sepsis and septic shock (p&lt;0.05).

Conclusion
At the time of ICU-admission, circulating levels of neprilysin independently predicted 30-day mortality in patients following cardiac surgery or heart valve intervention, but not in critically ill medical patients. Furthermore, patients suffering from sepsis and septic shock displayed significantly increased circulating neprilysin levels.
Prognostic impact of anemia in acute coronary syndrome patients
Authors: Carvalho P , Monteiro J , Carvalho C , Bernardo M , Fontes P , Mateus P , Goncalves F , Moreira I 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Anemia commonly accompanies acute coronary syndromes (ACS) and is associated with worst outcomes. Over the last decade several trials have investigated the prognostic impact of hemoglobin (Hb) levels in the context of acute coronary syndrome (ACS), both in the short-term, during hospitalization, and in the long-term, albeit mainly up to three months, with only a few trials assessing one-year outcomes.

Methods
This was a retrospective study of ACS patients admitted to a single center between October/2011 and September/2018, in whom Hb level was evaluated on admission. Anemia was defined as defined as Hb ≤ 13g/dL for males and Hb ≤ 12g/dl for females. Baseline characteristics, management, and outcomes were compared between patients with and without anemia. The primary endpoint, MACE, was a composite of acute coronary syndrome, stroke and global death events. The secondary endpoint was cardiovascular death.

Results
A total of 578 patients were selected, with a mean age of 66.7±13.1 years, 74.9% were male, 42.6% had a ST-Elevation Myocardial Infarction and 18.9% met criteria for anemia. These patients had more comorbidities: arterial hypertension (78.0% vs 60.6%; p=0.001), diabetes mellitus (25.7% vs 50.5%, p=0.001), peripheral artery disease (3.9% vs 10.1%, p=0.01) and were older (mean age 64.8±13.1 vs 72.1±11.0 years, p&lt;0.001). The non-anemic group had a higher percentage of smokers and, during hospitalization, was more often submitted to percutaneous coronary angioplasty. Antithrombotic therapy given during hospitalization and on discharge was similar in both groups.
During a median follow-up of 41 months (IQR: 20-59), 91 patients (15.7%) died and 104 (18%) had a MACE event. In a multivariate regression analysis, after adjusting for possible confounders, anemia was an independent predictor of MACE events (HR 1.64, 95% CI: 1.07-2.50) and cardiovascular death (HR 2.24, 95% CI: 1.26-3.96).

Conclusion
Anemia is highly prevalent in the ACS setting and the presence of anemia was independently associated with worse outcomes, particularly mortality.
FGF-23 as a predictor of 6-month outcome and response to therapy in acute heart failure
Authors: Plonka J , Olejnik A , Wezyk-Wylegala N , Rzepiela L , Dabrowska K , Klus A , Gawrylak- Dryja E , Bil-Lula I , Gierlotka M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by a grant from the Institute of Medical Sciences, Univeristy of Opole, Poland

Background
FGF-23 is a well-known marker for phosphate metabolism and independent risk marker for cardiovascular mortality. FGF-23 can stimulate pro-fibrotic factors in myocytes and finally promote cardiac fibrosis. There is also evidence that FGF-23 levels can predict the response to the therapies in acute heart failure (AHF) patients. The aim of the study was to assess whether FGF-23 level change during an episode of AHF as well as its long-term prognostic utility in population of AHF patients. Additionally, we also aimed to evaluate correlations of FGF-23 levels with the response to therapy.

Methods
We analysed 112 consecutive patients admitted to ICCU between June 2019 and January 2021 due to high-risk AHF. Guidelines guided therapy of heart failure was introduced. Blood samples were collected on admission, at discharge as well as at the 30-day. Patients were then followed-up for all-cause mortality and rehospitalisations due to heart failure.

Results
Patients (N=112; median age 68 years, 75% men, median left ventricular ejection fraction 30% [IQR 20-38%]) had median admission levels of FGF-23 = 1278 pg/ml [283-4429], Klotho protein = 670 pg/ml [501-851], NT-proBNP = 5361 ng/l [3019-13182], and GDF-15 = 4582 pg/ml [3028-9081]. FGF-23 decreased by 70% from admission to discharge (P&lt;0.001) and then remain relatively stable up to 30-day. During median 478 days follow-up 40 patients (36%) died or were hospitalised due to heart failure - they were older, more often with new onset AHF, of ischaemic aetiology and diabetics. Patients with high levels of FGF-23 (in the 4th quartile, both on admission or at discharge) had higher mortality (Figure A and B). Model combining FGF-23, Klotho protein, NT-pro BNP, and GDF-15 adjusted for age and sex showed satisfactory predictive value of unfavourable prognosis in ROC analysis (Figure C).

Conclusion
Levels of FGF-23 on admission in patients with AHF are significantly elevated and lowers during appropriate effective therapy what indicates the utility of FGF-23 as a typical biomarker. High values of FGF-23 are associated with higher 6-month mortality. Reduction of the FGF-23 during hospitalization can serve as a marker of AHF compensation, thus FGF-23 could be a valuable tool for assessing response to treatment.
The impact of COVID-19 pandemic on type A aortic dissection care
Authors: Manla Y , Bhatnagar G , Aljabery Y , Kakar V , Bajwa G , Sanger S , Almahmeed W , Bafadel A , Khan U , Ahmed W , Gobolos L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
COVID-19 created a challenging situation for cardiac surgery and associated acute care programs around the world. While non-urgent cases might be postponed, operating on life-threatening conditions, including type A aortic dissection (TAAD), must be sustained despite the ongoing pandemic. Therefore, we investigated the impact of the COVID-19 pandemic on our urgent aortic program.

Methods
36 individuals presenting with TAAD in a single centre were analysed from the pre-pandemic period (2019, n=16) and the pandemic era (2020, n=20). Retrospective data review was conducted on patient characteristics, TAAD presenting symptoms, operative techniques, postoperative outcomes and length of stay. A comparison was made between both eras applying appropriate testing methods, and a p-value &lt;0.05 was considered statistically significant.

Results
A 25% increase in TAAD referrals occurred during the pandemic era. Patients were featured by younger age of presentation in contrast to Western data (pre-pandemic group: 47.6 ± 18.7, and the pandemic group: 50.6 ± 16.2 years, p=0.6) but showed similar male predominance (4:1) in both groups. There was no statistical difference in baseline comorbidities between the groups. Length of hospital and intensive care unit stays were comparable between both groups. Low rates of postoperative complications were registered in both groups with no significant between-group difference.

Conclusion
Emergent surgical management remains essential in patients with TAAD regardless of the pandemic. Furthermore, temporary structural departmental re-configuration and optimal personal protective equipment utilisation warrant maintained satisfactory outcomes in such critical healthcare scenarios.
Patient mortality dynamics in intensive cardiac care: single department experience
Authors: Serpytis P , Striogaite G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Intensive cardiac care is celebrating 60 years anniversary since description of a first coronary care unit by Dr. Desmond Julian in 1961. The establishment of such units was a breakthrough in diagnosis, treatment, and the development of critical care medicine. For the last 20 years our intensive cardiac care department has been a leading centre in its field in Lithuania, admitting over 4000 patients each year. Assessment of mortality in intensive cardiac care units is one of the main indicators of quality of healthcare provided.

Purpose
To examine the dynamics of mortality of patients treated in our intensive cardiac care department in 2000-2020.

Methods
The de-identified data set of patients who were treated in our intensive cardiac care department in 2000-2020 was gathered from medical records retrospectively. The set consisted of total number of patients treated in the department, the number of patients treated for ST-elevation myocardial infarction (STEMI), the number of patients treated for non-ST-elevation myocardial infarction (NSTEMI), the number of patients treated for pulmonary embolism (PE), and the number of patients who died in each of these groups. The analysis of collected data was performed using MS Excel, IBM SPSS Statistics 26.0 programs. Paired Student’s t-test and Chi-square test were applied. Results were considered statistically significant at p&lt;0.05.

Results
The analysis population comprised 65583 patients who were treated between years 2000 and 2020 of which 15912 (24.26%) were treated for STEMI, 8609 (13.13%) for NSTEMI, and 1460 (2.23%) for PE. The overall patient mortality in 2000-2020 was 4.76%, patient mortality treated for STEMI was 8.07%, treated for NSTEMI – 4.88%, and treated for PE – 15.74%. Mortality was found to be significantly higher in the STEMI group than in the NSTEMI group (8.07% vs. 4.88%; p&lt;0.001). Mortality in patients treated for STEMI in 2000-2005, 2006-2010, 2011-2015, and 2016-2020 were also found to be statistically significantly different (p=0.001) and consistently decreasing (9.2% vs. 8.0% vs. 7.3% vs. 7.0%). There were no statistically significant differences in the mortality of patients treated for NSTEMI and PE at different time periods (p&gt;0.05) as observed in the STEMI group. Assessing all patients treated in 2000-2020, it was found that statistically significantly more patients died in 2016-2020 (5.2%) than in 2000-2015 (4.6%; p=0.01).

Conclusions
The highest mortality in patients treated in our intensive cardiac care department in 2000-2020 was observed in the group of patients treated for pulmonary embolism. A consistent decrease in mortality was observed in patients treated for ST-elevation myocardial infarction. The average total patient mortality rate in 2016-2020 was found to be statistically significantly higher than in the previous years.
Effect of modular cardiac rehabilitation on quality of life, exercise tolerance and psychological status in patients with myocardial infarction and COVID-19 infection
Authors: Bolatbekov BA , Trusheva KS , Baibolova MK , Kudaiberdieva GZ , Bolatbekova ZS , Kuramys S , Baimagambetov AK 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
COVID-19 worsens the prognosis in patients with cardiovascular diseases, including myocardial infarction (MI). In connection with this, cardiac rehabilitation (CR) programs must be adapted for this category of post-infarction patients. Little is known on effect of CR on quality of life and anxiety and depression in patients with MI and COVID-19.

Objective
The aim of the study was to evaluate the use of a modular CR program on quality of life, excercise tolerance, anxiety and depression in post-infarction patients recovered from COVID-19 infection during a pandemic.

Methods
Overall, 86 patients with previous COVID-19 infection were included in this prospective longitudinal study. We evaluated the parameters of quality of life according to the Seattle questionnaire, exercise tolerance according to the six-minute walk test, and the depression and anxiety rating scale (HADS) before and after applying the modular CR program.

Results
According to the computed tomography (CT) classification, the severity class of lung lesions was: grade CT1 -23%, CT2-48%, CT3-23% and CT4-6%. When assessing the quality of life before the start of the modular CR -74% complained of episodic attacks of angina pectoris, while at the end of the CR, only 5% of had chest pain (p&lt;0.05). Tolerance to physical activity according to the 6-minute walk test improved significantly from 245 ± 3.6 meters before CR to 355 ± 5.1 meters in dynamics (p=0.012). The depression and anxiety reduced significantly (p=0.0023) after CR: before the onset of modular CR 55% of patients were depressed in and 69% exhibited anxiety; after CR, depression in 10.4% of patients had depression and 7% - anxiety.

Conclusions
The use of a modular CR program in postinfarction patients with COVID-19 improves the quality of life, exercise tolearnce and psychological status.
Kounis syndrome leading to triple-vessel coronary artery ischaemia due to simultaneous coronary spasm, plaque erosion, and multiple stent thrombosis: a case report
Authors: Yamamoto Hiroyuki , Otake Hiromasa , Tanimura Kosuke , Hirata Ken-ichi 
Published: May 2022

AbstractBackgroundKounis syndrome (KS) is an acute coronary syndrome (ACS) induced by allergic reactions. Currently, there are three variants of KS based on the mechanism and onset of ACS. We report a rare case of KS, wherein ACS was caused by all KS variants.Case summaryA 68-year-old man with a history of percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction of the left anterior descending artery 16 days ago underwent a staged PCI for the mid-left circumflex artery (LCx) stenosis under optical coherence tomography (OCT) guidance using low-molecular-weight dextran (LMWD). During OCT examination, the LMWD induced an anaphylactic reaction. The patient was immediately administered medications to manage the anaphylaxis; however, he complained of chest discomfort. Coronary angiography and subsequent intravascular ultrasound revealed a newly developed coronary thrombus in the proximal LCx. Furthermore, coronary spasm or multiple stent thromboses occurred sequentially in all coronary arteries, resulting in triple-vessel coronary artery ischaemia. Balloon angioplasty was performed under intra-aortic balloon pumping, which could rescue the patient. The patient was discharged without any complications 11 days post-KS, under a 7-day anti-histamine regimen. No further cardiovascular events had occurred by 1-year follow-up.DiscussionThis case documented the clinical course of KS caused by LMWD, wherein all KS variants occurred sequentially. Early recognition of KS and appropriate management with anaphylaxis medication and balloon angioplasty under mechanical circulatory support effectively prevent vascular morbidity. Interventionalists should be aware of this rare and serious complication of PCI.
Iatrogenic pacemaker-induced ventricular arrhythmia: a case report
Authors: Pooranachandran Vivetha , Hodson Tim , Nicolson Will , Ng Ghulam Andre 
Published: May 2022

Abstract

Background
Minimizing right ventricular (RV) pacing to reduce the progression of heart failure is an established practice. Proprietary algorithms to reduce unnecessary RV pacing have been incorporated into both simple and complex cardiac pacemaker devices, for reducing the possibility of heart failure and arrhythmias.

Case summary
We present a case of a 43-year-old male implanted with a dual-chamber primary prevention implantable cardioverter-defibrillator (AUTOGEN EL, Boston Scientific) for sudden cardiac death. At the time of implant, the patient had hypertrophic cardiomyopathy with mild left ventricular (LV) systolic impairment, and sinus rhythm with intact atrioventricular (AV) conduction. The patient developed progression of his disease with symptoms (dyspnoea) and LV impairment. This led to a decision to activate the minimal RV pacing algorithm (RYTHMIQ™). A deterioration in AV conduction caused intrinsic ventricular beats to fall in the atrial blanking period, and subsequent VVI backup pacing resulted in R on T pacing. This induced ventricular arrhythmia. RYTHMIQ™ was subsequently deactivated, and the patient has had no further device-induced arrhythmias.

Discussion
Numerous studies have demonstrated the adverse effect of RV pacing on LV function. Minimizing RV pacing is, therefore, encouraged in individuals with intact AV conduction. However, underlying conduction abnormalities must be assessed prior to activating algorithms designed to minimize RV pacing. This case demonstrates the importance of careful intracardiac electrogram interpretation and individual case-based device programming, to avoid device-induced complications.