bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intra-aortic balloon pump in patients with acute advanced heart failure. Results from a single-center study
Authors: Panagiotou C , Adamopoulos S , Sbarouni S , Miliopoulos D , Gkouziouta A , Bonios M , Leontiadis V , Voudris V , Rallidis L , Iliodromitis E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients with advanced heart failure are frequently referred to cardiac intensive care unit (CICU) for hemodynamic support. Despite optimum pharmacological therapy many of these patients persist in critical condition, demanding short term circulatory support until recovery or heart transplantation. Intra-aortic balloon pump is commonly used in patients with advanced heart failure in order to stabilize hemodynamically compromised patients as bridge to decision for further therapies.

Purpose
To investigate the outcomes of patients with acute advanced heart failure referred to cardiac intensive care unit and supported with short term mechanical support. To explore the hemodynamic effects of the Intra-aortic balloon pump therapy in these patients.

Material & Method
We retrospectively analyzed the data from 104 patients with acute advanced heart failure (either as worsening of existing symptoms of chronic HF or as first onset of HF). All patients had severe left ventricular dysfunction, which was frequently associated with right ventricular dysfunction and increased NT pro BNP levels. Demographic data were collected including co-morbidities. Laboratory data included NT-pro BNP, total bilirubin, serum creatinine, urea and baseline e GFR (MDRD Formula). All patients received IABP support and underwent right heart catheterization. Measurements were made before and after the insertion of the IABP. The study has been approved by the Scientific Committee and the Ethics Committee of the Hospital.

Results
The mean age of the sample was 44 ± 12 years. 76 patients (73, 08%) were male. 20 patients (19, 23%) were of ischemic etiology. The median time on IABP support for the entire cohort was 13 days (3 – 41, 25). There was statistically significant decrease in the NT-pro BNP levels (p&lt;0, 0001). There was improvement in renal function (e GFR (p&lt;0, 0001) and urea levels (p&lt; 0,001)). There was statistically significant improvement in the right heart catheterization measurements (decrease of the right atrium pressure (p &lt;0, 0001), of the PA pressure (p&lt;0,001), and of the pulmonary capillary wedge pressure (p&lt;0,001)). IABP provided clinical stabilization in 88 patients (87, 62%), that is completed pre-transplant evaluation and proceeded in surgery with permanent mechanical support or heart transplantation or transfer to regular ward, while 16 patients (15, 38%) ended up in CICU while being on IABP.

Conclusions
In this single center study the use of IABP improved the laboratory findings and the hemodynamic status of patients admitted in the cardiac intensive care unit with acute advanced heart failure. It was an effective method of managing patients as bridge to decision for further therapies.
12-lead post-ROSC electrocardiogram discriminates survival to hospital discharge. A sub-analysis of the PEACE study
Authors: Gentile FR , Baldi E , Schnaubelt S , Caputo ML , Clodi C , Bruno J , Compagnoni S , Benvenuti C , Domanovits H , Burkart R , Primi R , Ruzicka G , Holzer M , Auricchio A , Savastano S 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Once the return of spontaneous circulation (ROSC) after an out-of-hospital cardiac arrest (OHCA) is achieved the acquisition of a 12-lead electrocardiogram (ECG) is strongly recommended in order to determine candidates for urgent coronary angiography. However, little is known so far about the association of ECG features and survival to hospital discharge in OHCA patients.

Purpose
The aim of the present study is to assess whether ECG features could be associated with survival to hospital discharge.

Methods
We analysed all the post-ROSC ECGs collected from January 2015 to December 2018 in three European centres. For every ECG, the main features were analysed and filed in the database together with the pre-hospital data collected for every patient according to the Utstein style. Every ECG was evaluated by two independent cardiologists and in case of doubt a third one was asked to solve the dispute.

Results
We collected 370 ECGs: 287 males (77.6%); median age 62 years old (IQR 53-70 years); 121 from center 1 (32.7%), 38 from center 2 (10.3%) and 211 from center 3 (57.0%). In Cox univariable regression, age older than 62 years [HR 1.7 (95%CI 1.1-2.4), p=0.007], QRS wider than 120 msec [HR 1.87 (95%CI 1.3-2.7), p&lt;0.001], the presence of ST elevation in more than one segment [HR 1.7 (95%IC 1.2-2.5), p=0.003], the presence of left bundle branch block (LBBB) [HR 1.7 (95%CI 1.1-2.9), p=0.03] and the presence of a right bundle branch block [HR 1.8 (95%CI 1.1-2.8), p=0.01] were associated with death before hospital discharge. In multivariable Cox regression, after correction for the ROSC-to-ECG time, age older than 62 years [HR 1.6 (95%CI 1.1-2.3), p=0.01], QRS wider than 120 msec [HR 1.7 (95%CI 1.2-2.5), p=0.004] and the presence of ST elevation in more than one segment [HR 1.7 (95%CI 1.2-2.5), p=0.004] were confirmed to be independently associated with death before hospital discharge. By assigning one point to each one of these three variables, we have created a score ranging from 0 to 3. The rate of survival to hospital discharge was found to be significantly different in the four categories [score=0: 80.8%; score=1: 71.2%; score=2: 61.9%; score=3: 34.4%; p&lt;0.001, p for trend &lt;0.001]. Lastly, with a Cox regression model, assuming score 0 as a reference, we confirmed how scores 2 or 3 were significantly associated with death before hospital discharge [HR 1.9 (95%CI 1-3.5), p=0.037 e HR 5.1 (95%CI 2.6-10.1), p&lt;0.001 respectively].

Conclusions
Our study proves that after an out-of-hospital cardiac arrest, post-ROSC ECG features can be used for prognostic stratification in addition to the selection of patients who may benefit from urgent coronary angiography.
Age-dependency performance of diagnostic prediction rules for pulmonary embolism
Authors: Silva BV , Jorge C , Rodrigues T , Placido R , Rigueira J , Alves Da Silva P , G Almeida A , J Pinto F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Age affects the performance of the diagnostic tests to rule out pulmonary embolism (PE), particularly with a decrease in specificity, leading to an overuse of computed tomography pulmonary angiography (CTPA). Current guidelines advice to consider using the age-adjusted cut-off in patients older than 50 years, but no specific recommendation is provided for very old patients.
We aimed to compare the age-dependency of the diagnostic accuracy of the standard approach (based on Wells and Geneva scores combined with a D-dimer cut-off of 500 ng/mL), with three alternative strategies (age-adjusted, YEARS and PEGeD algorithms) in patients admitted to the Emergency Department (ED) due to PE suspicion.

Methods
Consecutive outpatients admitted to the ED who underwent CTPA due to PE suspicion were retrospectively evaluated. The diagnostic accuracy was calculated and compared among the different diagnostic prediction rules and stratified by age.

Results
We included 1402 patients (mean age 69 years, 54% female). PE was confirmed in 25% (n=353), 86% occurred in patients over 50 years. Table 1 and 2 represents the sensitivity and specificity of diagnostic prediction rules stratified by age.
For all diagnostic strategies, specificity decreases with age. In patients over 80 years, the standard approach’s specificity could be as low as 8%. Compared to the standard approach, the age-adjusted strategy was associated with higher specificity over 50 years (p=0.008 for patients aged 51-60 years; p&lt;0.001 for patients over 60 years), with similar sensitivities for patients under 70 years and a non-statistically significant decrease in sensitivity in patients over 70 years (p=0.03). YEARS and PEGeD algorithms had the highest specificities for all ages (p£0.001). Regarding sensitivity, except for patients aged between 61 and 70 years, YEARS and PEGeD showed lower sensitivity than the standard and age-adjusted approaches for all ages (p&lt;0.001), particularly in patients under 60 years (sensitivity of 81% in patients aged between 51-60 years).

Conclusion
Compared to the standard approach, an age-adjusted strategy increased specificity with a non-significant decrease in sensitivity only in patients older than 70. YEARS and PEGeD algorithms had the highest specificity across all ages yet were associated with a significant decrease in sensitivity.
Heart failure in myocardial infarction with non-obstructive coronary arteries: predictors and prognosis
Authors: Santos M , Almeida I , Paula S , Santos H , Almeida S , Tavares J , Santos L , Almeida ML 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure (HF) is a frequent complication of acute coronary syndromes (ACS). However, 5-15% of patients admitted with suspected acute myocardial infarction have no significant lesions on coronary angiography (&gt;50%). Contrary to initial beliefs, MINOCA is not a benign disease, given that mortality and incidence of MACE is similar to ACS.

Objective
To evaluate predictors and prognosis of HF in the setting of MINOCA.

Methods
Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Patients (pts) without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without HF; GB - pts with HF during hospitalization.

Results
HF occurred in 63 (5.2%) out of 1218 pts with MINOCA. There were no differences between G regarding gender (p=0.779). GB pts were older (72±10 vs 65±13, p&lt;0.001), had higher rates of arterial hypertension (88.9% vs 68.7%, p&lt;0.001), diabetes (45% vs 27.5%, p=0.003), valvular disease (15.8% vs 2.1%, p&lt;0.001), previous HF history (17.2% vs 6.2%, p=0.004), kidney dysfunction (15.1% vs 4.6%, p=0.006) and dementia (8.8% vs 0.7%, p&lt;0.001). GA had higher rates of smoking habits (22.4% vs 3.3%, p&lt;0.001). GB had higher heart rate at admission (92±25 vs 75±17, p&lt;0.001), and higher rates of KK&gt;1 (71.4% vs 6.3&, p&lt;0.001), atrial fibrillation (25.5% vs 7.9%, p&lt;0.001) and left branch bundle block (LBBB) (8.7% vs 1.4%, p=0.007). GB presented higher rates of kidney dysfunction (creatinine&gt;2.0mg/dL) at admission (20.8% vs 4.8%, p&lt;0.001)) and during hospital stay (31.6% vs 9.8%, p&lt;0.001), lower haemoglobin levels at admission (13±1.8 vs 13.8±1.8, p=0.008) and during hospital stay (11.1±2.4 vs 12.7±1.8, p&lt;0.001), higher BNP levels (BNP&gt;400pg/ml) (100% vs 18.1%, p&lt;0.001), and higher rates of left ventricle systolic dysfunction (LVEF&lt;50%) (55.6% vs 17.6%, p&lt;0.001).
Logistic regression confirmed that KK&gt;1 (p&lt;0.001, OR 37.4, CI 13.6-102.7), LBBB (p=0.005, OR 10.1, CI 2.0-51.0), LV dysfunction (p=0.002, OR 8.3, CI 2.1-32.1) and smoking (p=0.046, OR 0.096, CI 0.01-0.96) were predictors of HF in the setting of MINOCA. Survival analysis confirmed GA had better prognosis regarding 1 year mortality compared to GB (p&lt;0.001).

Conclusion
As expected, HF in the setting of MINOCA is associated with poorer prognosis. Several features may help predict the HF occurrence during hospitalizations, allowing an earlier treatment.
Cardiogenic shock prognosis according to the type of infarction: STEMI vs non-STEMI. Acute-phase and 5-year mortality
Authors: Martinez Membrive MJ , Rueda Sobella F , Garcia Garcia C , Labata Salvador C , Oliveras Vila T , Montero Aradas S , Ferrer Massot M , El Ouaddi N , Serra Flores J , Lupon Roses J , Bayes Genis A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Germans Trias i Pujol

Background
Cardiogenic shock (CS) is a severe complication of myocardial infarction (MI) and carries a high mortality. Clinical profile and prognosis of these patients could differ depending on the electrocardiographic pattern at admission. The objective of this study is to demonstrate these differences.

Methods
Prospective register of patients with MI complicated with CS admitted to the acute cardiac care unit of a tertiary hospital between 2010 and 2019. Clinical characteristics and mortality at 30-day and 5-year were compared according to the presence (STEMI) or absence (NSTEMI) of ST-segment elevation.

Results
This study included 239 patients, 79.5% had STEMI and 20.5% had NSTEMI. There were no differences in age (69 vs. 71 years, p=0.330), gender distribution (22.4% vs. 27.4% women, p=0.486) and ejection fraction (33% vs. 30%, p=0.231). However, patients with STEMI had more extensive MI (CK-MB peak 279 vs. 85 ng/ml, p&lt;0.001) and mechanical complications (17.9% vs. 0% p&lt;0.001). Nevertheless, patients with NSTEMI had greater prevalence of hypertension (81.6% vs. 62.6%, p=0.012), diabetes (53.1 vs. 36.3%, p=0.033), peripheral arteriopathy (34.7% vs. 13.7%, p=0.001), previous heart failure (14.3% vs. 3.7%, p=0.005), previous MI (44.9% vs. 10.0%, p&lt;0.001), percutaneous coronary angioplasty (20.4% vs. 10.0%, p=0.047) and coronary artery bypass grafting (10.2% vs. 2.1%, p=0.020). This last group had more prevalence of three-vessel disease (80.4% vs. 34.9%, p&lt;0.001) and main left artery (58.7% vs. 20.6%, p&lt;0.001).
STEMI patients had higher 30-day mortality (59.5% vs 36.7%; p=0.004), but this difference progressively diminished. As a result, 5-year survival had no significant differences. After adjusting for main clinical predictors, STEMI was independently associated with 30-day mortality (HR 1.99), but this association disappeared when the follow-up was extended to 5 years.

Conclusions
Patients with CS and STEMI had more extensive infarcts and with more mechanical complications than NSTEMI. Patients with NSTEMI and CS had more cardiovascular risk factors, previous coronary artery disease, and multi-vessel involvement. 30-day mortality of STEMI with CS was higher than in NSTEMI, although 5-year mortality did not offer significant differences.
Acute cardiac injury (ACI) in COVID-19 pneumonia
Authors: Erba M , Ciarrocchi F , Dammassa V , Colombo C , Mojoli F , Tavazzi G 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Since the SARS-CoV2 break-out many reports focused on the role of cardiovascular system involvement in the patient’s outcome(1). However, few descriptions exist including only patients with severe ARDS admitted to general ICU.

Methods
We enrolled adult patients with severe ARDS related to COVID-19 infection consecutively admitted to ICU between February 2020 and March 2021. Acute cardiac injury was defined as a rise and fall of cTnI above the 99th percentile (i.e., ≥ 47 ng/L)(2). Hs-TnI was measured at admission and during ICU stay. Echocardiographic examinations were performed at ICU admission and at the time of worst cTnI.
Left ventricular (LV) and right ventricular (RV) systolic dysfunction were defined respectively as LV ejection fraction (LVEF) &lt; 50% and as tricuspid annular plane systolic excursion (TAPSE) &lt; 16 mm.

Results
A total of 148 patients were included in the analysis. Acute cardiac injury was present in 65 (44.9%) cases at admission. Forty-seven (21.8%) patients had isolated depressed LVEF, 13 (9.0%) had isolated RV systolic dysfunction and 24 (16,4%) presented with biventricular systolic dysfunction.
Eithy-two (56.1%) had a worsening of hs-TNI values during the admission of whom a consensual worsening of LVEF and TAPSE was observed in respectively 32 (21.8%) and 28 (19.2%) patients.
Cardiac injury at ICU admission yielded an increased risk of in-hospital mortality (OR 1.30 [95% CI 0.71 – 2.38]) (Figure 1 – left panel) as well as the presence of impaired echocardiography (OR 1.85 [95% CI 1.01 – 3.40]) (Figure 1 – right panel). Worst hs-TNI correlated with worst procalcitonin (PCT) values (p &lt;0.001 r20.81) in case of on-going septic shock and 85 % of patients with RV dysfunction had either evidence of pulmonary thrombus at CT scan or high inspiratory peak pressure (&gt; 30 cmH2O) at mechanical ventilation (respectively, p &lt; 0.001 and p &lt;0.01).
Bivariable analysis adjusted for the inverse probability of having an impaired echocardiographic exam confirmed the increased risk of in-hospital mortality in patients with cardiac injury (OR 2.01 [95% CI 1.28 – 3.15]) and in presence of altered echocardiography with RV dysfunction yielding a higher risk (OR 2.42 [95% CI 1.29 – 4.55]) compared with biventricular impairment (OR 1.86 [95% CI 0.87 – 4.00]) and isolated LV dysfunction (OR 1.30 [95% CI 0.77 – 2.19]) (Figure 2).

Conclusion
The use of echocardiography for the detection of cardiac dysfunction, has shown a greater correlation with mortality than the identification of acute cardiac damage using laboratory parameters. Of all the parameters obtained with the echocardiography, right ventricular dysfunction demonstrates the greatest correlation with mortality compared to left or biventricular dysfunction. However, the major cause of LV dysfunction in our population occurred during septic shock while RV dysfunction seemed to be due to pulmonary embolism and/or acute cor pulmonale ARDS-related.
Identification of triggers associated with health care-related adverse events in a cardiac care unit
Authors: Maruri Sanchez R , Martin Asenjo R , Puerto E , Dominguez Perez L , Vicent L , Durante Lopez A , Bruna V , Galan D , Moreno G , Arribas F , Bueno H 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
health care-related adverse events (HCRAE) are a safety concern with serious consequences for hospitalized patients. In medical literature there is a lack of evidence about the incidence, characteristics and prevention of HCRAE in a cardiac care unit (CCU). This study evaluates the utility of predefined triggers from the Global Trigger Tool method that are associated with the appearance of HCRAE, for their early detection and prevention in critical cardiac patients.

Purpose
validation of a set of predefined triggers from the Global Trigger Tool method that allow the detection of HCRAE in patients admitted to a CCU.

Methods
retrospective observational study. A review of medical history documents from a group of patients admitted to a CCU will be carried in search of HCRAE. The presence or absence of a set of predefined triggers from the Global Trigger Tool method will be analyzed in these patients. Statistical analysis will establish the relationship between the presence of these triggers and the incidence of HCRAE, as well as their sensitivity and specificity to detect these events.

Results
among 1086 patients admitted to a CCU during 2017, 120 were randomly evaluated. Fifty-nine patients (49%) experienced HCRAE. The total number of these events was 153 (at a median of 0 events per patient, Q1-Q3: 0-1). Forty-four predefined triggers from the Global Trigger Tool method were evaluated in all patients, regardless of whether or not they presented HCRAE. A median of 2 (Q1-Q3: 1-7) triggers per patient were detected. The mean review time for all triggers was 6.4 (± 3.07) minutes per patient. Among the 44 triggers evaluated, 7 were significantly associated with the incidence of HCRAE. These triggers are shown in Table 1. These triggers showed a sensitivity of 81% and a specificity of 90% for the detection of HCRAE. The ROC curve is shown in Figure 1.

Conclusions
HCRAE have serious consequences por patients; their prevention is a main goal for patient safety. In medical literature, there is a lack of evidence about this topic in the context of a CCU. In the present study, the incidence of HCRAE was evaluated in 120 critical cardiac patients. Forty-nine percent of patients experienced one or more HCRAE. Forty-four predefined triggers from the Global Trigger Tool method were evaluated; 7 of them were significantly associated with the incidence of HCRAE. These triggers showed a sensitivity of 81% and a specificity of 90% to detect HCRAE.
GRACE score - is it good for all NSTEMI patients
Authors: Santos M , Santos H , Paula S , Almeida I , Figueiredo M , Almeida S , Tavares J , Santos L , Almeida ML 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Patients (P) with a non-ST elevation myocardial infarction (NSTEMI) have a heterogenous prognosis and early risk stratification at admission is essential. GRACE score is validated to estimate in-hospital outcomes, as well as long term prognosis.

Objective
Evaluation of discriminatory capacity of GRACE score in P &lt;65 years versus ≥65 presenting with NSTEMI.

Methods
Based on a single-center retrospective study, data collected from admissions between 1/01/2016 and 11/12/2019. Patients with cardiac arrest or hemodynamically unstable patients at admission were excluded. GRACE score was calculated using Killip-Kimball classification as a surrogate of heart failure. P were divided in 2 groups (G): G1 if &lt;65 years old, G2 if ≥65 years. We evaluated the discriminatory capacity of GRACE score in predicting in-hospital MACE in both groups through ROC-curve analysis.

Results
We identified 405 patients with NSTEMI, 62.7% were males with an average age of 68.4±12.3 years old. Mean GRACE in global population was 118±28.3 points, lower in G1 P (G1 92.6±22.6, G2 130±21.2, p&lt;0.001). At univariate analysis, GRACE score was predictor of MACE in G1 (p=0.05, OR 1.05) and G2 p=0.026, OR 1.03). Its discriminatory capacity was acceptable: for G1 the area under the curve (AUC) was 0.687 and in G2 AUC 0.785. Given the lower discriminatory capacity in G2, the authors determined other predictor factors (excluding GRACE) to accurate risk stratification in this G. At univariate analysis, predictor factors for MACE were diabetes (p=0.006, OR 5.4), left ventricle branch block (p=0.011, OR 2.2) and haemoglobin at admission (p=0.003, OR 0.63). At multivariate analysis, both diabetes (p=0.002) and haemoglobin (p=0.031) were independent predictor factors for MACE.

Conclusion
In our center, GRACE score was a better predictor for younger patients, while for other patients other factors, such as diabetes and haemoglobin at admission must be taken into account to assess risk stratification.