bluuebunny/crossref_metadata_2025_split huggingface dataset:
Inpatient myocardial perfusion imaging characteristics of patients admitted with suspected type 2 myocardial infarction
Authors: Swinn T , Moncrieff G , Aziz S , Gogola L , Skyrme-Jones A , Wong C , Dastidar A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
ESC defines a type 1 myocardial infarction (T1MI) as "MI caused by atherosclerotic coronary artery disease and usually precipitated by atherosclerotic plaque disruption" and type 2 myocardial infarction (T2MI) as "ischaemic myocardial injury in the context of a mismatch between oxygen supply and demand". In practice it can be difficult to differentiate between MI types and the role of myocardial perfusion imaging (MPI) in making this distinction remains unclear.

Purpose
To establish whether suspected T2MI has different characteristics on MPI compared to suspected T1MI.

Methods
All inpatient MPI scans at our institution between 01/03/2018 and 28/02/2020 were retrospectively reviewed. Patients were excluded if they had a previous diagnosis of coronary artery disease, an invasive coronary angiogram prior to MPI, or a maximal troponin T &lt; 14ng/l. Diagnoses were categorised based on review of scan request information. Echocardiography images were reviewed if within 30 days of MPI.

Results
58 patients were included: 28 with suspected type 2 MI and 30 with suspected type 1 MI (mean age 70 vs. 75). There was no statistically significant difference in maximal troponin T between groups (T2MI 394.0 ng/l, T1MI 415.6 ng/l; p=0.90). 50% T2MI patients and 53% T1MI patients had a territorial defect on MPI (fully reversible defect 25% vs. 17%, partially reversible defect 7% vs. 33%, irreversible defect 14% vs. 3% for T2MI vs T1MI respectively). 25% T2MI patients had an area &gt;10% LV myocardium volume showing reversibility, compared with 33% T1MI (p=0.49). Both groups had similar proportions of left ventricular (LV) impairment (both had 65% of patients with normal LV ejection fraction) and prevalence of regional wall motion abnormalities ((RWMA) 39% for T2MI, 35% for T1MI, p=0.76) on echocardiography.

Conclusions
A clinically significant proportion of the suspected T2MI group had territorial ischaemia. Additionally, both patient groups demonstrated similar proportion of patients with reversible ischaemia and of LV systolic dysfunction. Therefore differentiation between T2MI and T1MI can be challenging both clinically and with MPI. Prospective studies are required to establish the optimal methods for making the distinction between types of MI.
Association between periodontal pathogens from the red complex and inflammation in patients with acute coronary syndromes
Authors: Halatiu VB , Rodean I-PR , Benedek I , Benedek TH 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Periodontal disease (PD) is an inflammatory condition that increases cardiovascular risk and favours development of acute coronary events; however, the association of periodontal pathogens and inflammatory markers in patients with acute coronary syndromes (ACS) has not been elucidated so far.

Purpose
the aim of this study was to evaluate the association between periodontal pathogens of the red and orange complex and inflammatory biomarkers in patients with ACS.

Methods
Sixteen patients with ACS and concomitant PD were enrolled in the present study. All patients underwent a complex dental examination, including DNA sampling collection from the periodontal pocket. The study population was divided into two groups according to the presence of germs from red, respectively orange complex: group 1 – 9 patients with germs from red complex (RC group) and group 2 – 7 patients with germs from red-orange complex (ROC group). Inflammatory status was assessed on the basis of interleukine 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, metalloproteinase (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), C reactive protein (CRP), alkaline phosphatase (AF) and sST2 and lymphocytes to monocytes ratio.

Results
Germs from red complex (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) were more frequent and more expressed compared with those from orange complex (p=0.0008). There was no significant correlation between RC and RCO group and inflammatory markers; however, P-selectin level (185,4 ± 66,73 vs 89,62 ± 40,94 ng/ml, p=0.005) was higher in RC group, while AF level at baseline (47,83 ±12,53 vs 75,72 ±24,42 UI/l, p=0.006) and in day 7 (52,83 ± 6,122 vs 70,95 ± 9,71 UI/l, p =0.01) was more expreesd in ROC group. A significantly higher lymphocytes to monocytes ratio was identified in patients with ROC compared with those with RC only (3,2 ± 1,44 vs 10,94 ± 12,75, p=0.01).

Conclusions
in patients with ACS and PD, the presence of germs from red complex in the gingival pocket is associated with increased blood vulnerability. The severity of the PD, expressed by the presence of germs of the red complex, is associated with a higher risk of developing acute coronary events.
Time-dependent prognostic value of bispectral index and suppression ratio during targeted temperature management: an early triage tool for treatment escalation plans
Authors: Arbas Redondo E , Rosillo-Rodriguez SO , Merino-Argos C , Marco-Clement I , Rodriguez-Sotelo L , Martinez-Marin LA , Velez-Salas A , Martin-Polo L , Caro-Codon J , Garcia-Arribas D , Armada-Romero E , Lopez-De-Sa E 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Post-cardiac arrest myocardial dysfunction contributes to morbidity in survivors of cardiac arrest (CA) and, in case of refractory shock, some patients will benefit from aggressive mechanical support. In this scenario, a non-invasive, reliable and real-time estimation of potential neurological recovery is required to establish personalized treatment escalation plans.

Methods
We prospectively collected data of bispectral index (BIS) and suppression ratio (SR) monitoring of adult comatose survivors of CA consecutively admitted to an acute cardiac care unit and managed with targeted temperature management (TTM). Neurological status was assessed according to the Cerebral Performance Category (CPC) scale.

Results
We included 340 patients, 72.1% had an initial shockable rhythm, 72 (21.2%) were females and their mean age was 61.7 ± 14.3 years. Throughout 3-month follow-up, 210 patients (61.8%) achieved a CPC of 1-2 and 130 (38.2%) a CPC of 3-5. Mean BIS values were significantly higher and median SR lower in patients with CPC 1-2 (Figure 1). An average BIS value &gt;26 during first 12 hours of TTM predicted good outcome with 89.3% sensitivity and 75.2% specificity (AUC of 0.86), while average SR values &gt;24 during first 12 hours of TTM predicted poor outcome (CPC 3-5) with 83.6% of sensitivity and 91.8% of specificity (AUC of 0.92). Hourly BIS and SR values exhibited a good predictive performance (AUC &gt; 0.85), starting as soon as hour 2 for SR and 4 for BIS.

Conclusions
BIS and SR real-time monitoring correlates with patient´s potential of neurological recovery after CA. This finding could help establish personalized treatment escalation plans that reduce consequences of inappropriate interventions, economic costs and uncertainty burden of the patient´s family.
Clinical outcomes of left main percutaneous coronary intervention in elderly patients at a long-term follow-up
Authors: Sanchez Perez I , Concepcion Suarez R , Gonzalvez Garcia A , Freites Esteves A , Martinez Del Rio J , Moron Alguacil A , Munoz Garcia M , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Lozano Ruiz Poveda F 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
The progressive aging of the population leads to higher prevalence of ischemic heart disease with an increased left main coronary artery (LMCA) disease. Elderly patients (&gt;75 years) represent an unfavorable subgroup because of their fragility, the frequent presence of multiple comorbidities associated and their especially high rate of surgical risk.

Purpose
The main objective of this study was to evaluate the efficacy and safety of percutaneous coronary interventions (PCI) in LMCA disease at 14 years follow-up in the elderly.

Methods
We prospectively included 217 consecutive patients (80.3 ± 2.4 years, 68.7% male) with LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after 14 years clinical follow-up (median 56 months).

Results
48.4% of patients had stable coronary disease and 51.6% acute coronary syndrome (42.4% Non-STEMI and 9.2% STEMI). 43.3% were diabetic patients and 45.9% presented moderate-severe left ventricular systolic dysfunction. Mean logistic EuroSCORE was 10.4% and 47.5% of lesions with Syntax score ≥ 32. LMCA bifurcation was affected in 78.8% of cases and the most frequently bifurcation technique employed was "provisional stenting" in 64.1% of cases. Second-generation drug eluting stent was used in 97.6% of cases. The intraprocedural complication rate was 4.5% with one death. During follow-up, MACE rate at 14 years was 19.9% (14.7% cardiac death, 3.2% non-fatal myocardial infarction, 4.1% TLR and thrombosis rate 0.5%). There were significant differences in the occurrence of MACE in patients with moderate-severe ventricular systolic dysfunction (p=0.01 OR 3.92; IC 95% de 1.26-8.57).

Conclusions
Left main PCI in elderly patients with high surgical risk provide very favourable results with a low rate of immediate complications in the procedure and a low rate of cardiac adverse events at a very long-term follow-up. However, patients with ventricular dysfunction have poor prognosis.
Real-world clinical outcomes of left main percutaneous coronary intervention in diabetic patients at a long-term follow-up
Authors: Sanchez Perez I , Concepcion Suarez R , Lozano Ruiz Poveda F , Gonzalvez Garcia A , Munoz Garcia M , Moron Alguacil A , Martinez Del Rio J , Negreira Caamano M , Mateo Gomez C , Aguila Gordo D , Soto Perez M , Cubides Novoa AF , Freites Esteves A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Coronary artery disease in diabetic patients has more aggressivity and tends to be a more complex disease characterized by small, diffuse, calcified, multivessel involvement that it presents higher in-stent restenosis rates after percutaneous coronary intervention (PCI). Besides, left main coronary artery (LMCA) disease has poor prognosis and it usually associates more severe lesions in other coronary arteries. Currently, the PCI in LMCA disease in these patients is controversial.

Purpose
The main objective of this study was to evaluate the efficacy and safety of PCI in LMCA disease in diabetic patients at a 14-year follow-up.

Methods
We prospectively included 228 consecutive patients (71 ± 11 years, 70.2% male) with LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the occurrence of major adverse cardiovascular events (MACE) defined as cardiac death, nonfatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 14-year clinical follow-up (median 66 months).

Results
53.1% of patients had stable coronary disease and 46.9% acute coronary syndrome (42.1% Non-STEMI and 4.8% STEMI). 40.3% of patients presented moderate-severe left ventricular systolic dysfunction. 63.6% had LMCA and ≥ 2 vessels disease and 43% had a SYNTAX score ≥ 33. Mean Logistic Euroscore was 7.2%. The most frequent bifurcation technique employed in LMCA was "provisional stenting" in 65.4% and zotarolimus-eluting stent was used in 75.8% of cases. Angiographic success rate was 99.6% and complication rate intra-procedure was 3.1% without intraoperative death. During follow-up, MACE rate at 14 years was 19.8% (14.4% of cardiac death, 6.6% of nonfatal myocardial infarction, 5.7% of TLR and thrombosis rate 0.4%). Higher MACE rate was significantly associated to left ventricular systolic dysfunction (p=0.04) and chronic kidney insufficiency (p=0.02). 22.2% of patients had angiographic follow-up.

Conclusions
PCI on LMCA in diabetic patients is safe and effective, with low complication rate and a low rate of long-term follow-up events. Left ventricular systolic dysfunction and chronic kidney insufficiency showed a significantly worse outcome.
Clinical results at a long-term follow-up of percutaneous coronary intervention in ostial left main coronary artery disease
Authors: Concepcion Suarez R , Sanchez Perez I , Lozano Ruiz Poveda F , Gonzalvez Garcia A , Martinez Del Rio J , Munoz Garcia M , Moron Alguacil A , Negreira Caamano M , Aguila Gordo D , Mateo Gomez C , Soto Perez M , Cubides Novoa AF , Freites Esteves A 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Left main coronary ostial lesions are notable for being found more commonly among middle-aged women with fewer conventional coronary artery risk factors and for lower long-term patency of internal thoracic grafts. Isolated ostial left main coronary artery (LMCA) disease is involved in the 18% of lesions and have a management approach do well either with percutaneous coronary intervention (PCI) or cardiac surgery. Continuous improvement in the devices and the emergence of better drug-eluting stents (DES) has improved the results of PCI in these high-risk lesions.

Purpose
The main objective of this study was to evaluate the efficacy and safety of PCI in ostial LMCA disease at a 14-year follow-up.

Methods
We prospectively included 109 consecutive patients (72± 12 years, 72.5% male) with ostial LMCA disease treated with PCI between June 2006 and June 2020. We evaluated the presence of major adverse cardiovascular events (MACE) defined as cardiac death, non-fatal myocardial infarction, target lesion revascularization (TLR) and stent thrombosis after a 14-year clinical follow-up (median 63.6 months).

Results
55.9% had stable coronary disease and 44.1% had acute coronary syndrome (35.9% Non-STEMI and 8.2% STEMI). 45% were diabetic patients and 36.6% presented moderate-severe left ventricular systolic dysfunction. The mean logistic EuroSCORE was 8.1 % and SYNTAX score was ≥ 23 in 72.5% of the patients. We implanted second-generation DES in the 83.5% of patients (76% zotarolimus-eluting stent) and post-dilatation was performed in the 68.8%. The angiographic success rate was 99%. Complication rate in the procedure was 5.5% without intra-procedure deaths. During follow-up, MACE rate at 14 years was 18.3% (13.7% of cardiac death, 4.6% of nonfatal myocardial infarction, 7.3% of TLR and thrombosis rate of 0.9%). 24.2% of patients had an angiographic follow-up.

Conclusions
In spite of high surgical risk, complex coronary anatomy and older aged patients, PCI in ostial LMCA disease is safe and effective with a low rate of major cardiovascular events at long-term follow-up.
Can we predict the coronary angiography result?
Authors: Santos M , Santos H , Paula S , Almeida I , Almeida S , Tavares J , Santos L , Almeida M 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
It is estimated that 5-15% of patients admitted with suspected acute myocardial infarction (AMI) have no significant lesions on coronary angiography (&gt;50%), an entity called MINOCA.

Objective
To identify predictors of non-significant coronary lesions in patients admitted with AMI

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 with significant coronary lesions; GB - pts with non-significant coronary lesions.

Results
MINOCA occurred in 1561 (20.6%) out of 6029 pts with AMI. There were no differences between G regarding age (p=0.745). GB pts were more frequently females (35.9% vs 24.9%, p&lt;0.001), had lower rates of smoking habits (21.9% vs 26.9%, p&lt;0.001), arterial hypertension (70.7% vs 73.4%, p=0.036), diabetes (31.1% vs 36.7%, p&lt;0.001), past history of MI (13.9% vs 23.5%, p&lt;0.001) and past history of stroke (5.0% vs 7.5%, p=0.002). There were no differences between G regarding symptoms at admission (p=0.359). At admission, GB had lower mean heart rate (76±18 vs 78±19, p=0.037), lower systolic arterial pressure (141±25 vs 144±28, p&lt;0.001), lower rates of KK&gt;1 (10% vs 12.2%, p=0.037), higher rates of atrial fibrillation (AF) (8.8% vs 6.8%, p=0.026), higher rates of normal ST-T segment (50.9% vs 29.6%, p&lt;0.001), and lower BNP levels (99±36.9 vs 157±64, p&lt;0.001). During hospitalization, GB pts used less diuretics (18.1% vs 26.1%, p&lt;0.001) and inotropes (0.5% vs 1.8%, p=0.007). GB had a lower prevalence of left ventricle dysfunction (&lt;50%) (20.4% vs 29.3%, p&lt;0.001), and less need of mechanical ventilation (0.1% vs 1.0%, p&lt;0.001), non-invasive ventilation (0.1% vs 1.6%, p&lt;0.001) and provisory pacing (0.1% vs 0.5%, p=0.011).
Logistic regression confirmed that being a female (p&lt;0.001, OR 2.7), a non-smoker (p=0.002, OR 1.4), a non-diabetic (p=0.001, OR 1.45), AF (p=0.001, OR 1.8), normal QRS (p&lt;0.001, OR 1.9) and normal LV function (p=0.009. OR 1.5) were predictors of MINOCA.
The G were similar regarding in-hospital MACE outcomes (in-hospital death, stroke or MI) (p=0.658) and 1 year outcomes, namely 1 year mortality (p=0.709) and readmission of cardiovascular causa (p=0.290).

Conclusion
Several clinical factor may help us predicting which patients will have a coronary angiography without significant lesions. However, the absence of significant lesions is not predictive of better in-hospital and 1 year prognosis.
Thrombocytopenia after transcatheter aortic valve implantation: prognostic value and mechanisms
Authors: Roca Guerrero C , Brito J , Silva B , Carrilho-Ferreira P , Jorge C , Cardoso P , Corte-Real H , Bordalo A , Canas-Silva P , Pinto F , Bras-Rosario L 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Thrombocytopenia post transcatheter aortic valve implantation (TPPT) in its most severe manifestation is an independent predictor of mortality. However, mechanisms that favors TPPT remain unknown.

Purpose
To establish the prognostic value and risk factors of TPPT in a real-life population of patients treated with transcatheter aortic valve implantation (TAVI) in a tertiary hospital.

Methods
We analyzed retrospectively clinical, laboratory, echocardiographic and procedure-related variables from 203 consecutive patients, treated with TAVI between January 2019 and October 2021.

Results
This cohort had mean age of 82,3 ±5,9 years, 56% male, 83% hypertensive, 62% dyslipidemia, 35% diabetic, 20% chronic kidney disease, 22% chronic obstructive pulmonary disease, 32% coronary artery disease, 20% had previous ICP, 38% Atrial Fibrillation (AF), 18% peripheral arterial disease, 12% neurovascular disease, 23% history of cancer, 10% pacemaker carriers. 50% of TAVIs were balloon-expandable and 50% self-expandable. Mean procedure duration was 138 ±109min, size 26,6±3mm, contrast dose 233 ±88mL.
During in-hospital stay 192/203 patients had TPPT. Platelets before TAVI, 187.000 (IQR 148.000-222.000) Vs a minimum post-TAVI (PlqMin) of 135.000 (IQR 105.000-164.000); P&lt;0,05. Platelet fall (DeltaPlq) 48.000 ±38.000. We observed a Minimum Kidney clearance (ClMin) 46 ±20,75mL/min/m2, a maximum ultrasensitive Troponin-T (Tr-TusMax) 250 ±450 pg/L, a Maximum C Reactive Protein (PCRMax) 6,68 ±6,4, and a Minimum Hemoglobin (HbMin) 9,8 ±1,7 g/dL. 31/203 (15,3%) patients were exitus at the end of follow-up.
We observed a non-lineal statistically significant association between TPPT quartiles and all-cause mortality (P&lt;0,05): 21 exitus occurred in the extreme quartiles (1 and 4) while only 11 at the central ones (2 and 3).
DeltaPlq was associated with PCRMax (Pearson 0,25; P&lt;0,001), CliMin (Pearson -0,23; P0,005), HbMin (Pearson -0,27; P 0,001), AF. The only protective factor for DeltaPlq was history of previous ICP. Among exitus patients PlqMin was observed later than in survivors (3,5 vs 2,2 days; P&lt;0,05).
TPPT’s quartiles, previous ICP, time to PlqMin, HbMin, PCRMax and Tr-TusMax were the variables found to be independent associated with all-cause mortality (P&lt;0,05).

Conclusions
The non-linear association between TPPT and mortality, the temporal relation between TPPT and mortality and the linear correlation between TPPT and HbMin and PCRMax suggest that late TPPT may have a mortality prognostic value through an increased risk of low Hb in the context of an increased inflammatory status. The fact that history of ICP was associated with les platelet fall suggests that revascularization, or ICP associated drug therapy, may confer protection against after TAVI mortality.
Evaluation of prognostic value of lung ultrasound in st-segment elevation myocardial infarction killip i
Authors: Carreras J , Simon-Ramon C , Vidal-Burdeus M , Rodriguez-Sotelo L , Giralt-Borrell T , Izquierdo-Marquisa A , Rivas-Lasarte M , Llao-Ferrando JI , Ariza-Sole A , Sionis A , Ribas-Barquet N , Vaquerizo-Montilla B 
Published: May 2022

Abstract

Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): Societat Catalana de Cardiologia (SCC)
Sociedad Española de Cardiología (SEC)

Introduction
About 80-90% of patients admitted for ST-segment elevation myocardial infarction (STEMI) present with no signs of heart failure at admission. Heart failure at admission is one of the most relevant prognostic factors in STEMI, whereas incidence and prognostic significance of HF developed during hospitalization is unclear. B-lines in lung ultrasound (LUS) provide useful diagnostic and prognostic information in heart failure patients with the potential to stratify the risk of complications in patients presenting with STEMI KKI.

Purpose
To assess the capacity of the lung ultrasound to predict heart failure developing or death during hospitalization in patients admitted for STEMI KKI

Methods
This is a prospective observational multicenter study. Consecutive patients admitted for STEMI KKI in four tertiary hospitals were included, exclusion criteria were patients with cardiac arrest at presentation, severe lung disease or hemodialysis. The LUS was carried out by an independent operator blinded to clinical data in the first 24 hours after admission. We counted B-lines using 8-scan site LUS protocol and divided patients in two groups : wet lung group (3 or more B-lines in at least one zone) and dry lung (no positive zone). The primary endpoint was a composite of clinical congestive heart failure, cardiogenic shock, or mortality during the index hospitalization.

Results
From June 2020 to November 2021, 221 patients STEMI KKI patients were included. Fifty-four patients (25,4%) had a wet lung according to the LUS. Seventeen patients (7,7%) presented the primary outcome (all of them developed congestive heart failure, 1 of them cardiogenic shock and 2 of them died during hospitalization). Fourteen in 54 wet-lung patients (25,9%) presented the primary outcome whereas only 3 in 167 (1,7%) of the dry-lung patients [relative risk of 14,4 (IC 95% 4,3-48,3)]. Patients who develop the primary outcome had no differences in NTproBNP at admission but had higher NTproBNP peak, higher troponin T peak, lower left ventricular ejection fraction and longer length of stay.

Conclusions
In patients admitted with STEMI KKI, presenting 3 or more B-lines at least at one lung zone in the LUS at first 24 hours after admission was strongly associated with worse prognosis during hospitalization.
LUS allows a better risk classification of patients and may potentially discriminate those with potential risk of complications during hospitalization from those with an excellent prognosis who can benefit from early discharge.