bluuebunny/crossref_metadata_2025_split huggingface dataset:
Incremental value of myocardial work in predicting beneficial response to aortic valve replacement in patients with aortic stenosis
Authors: Golanski G , Grzeskowiak K , Przybylski R , Protasiewicz M , Kubler P , Aleksandrowicz K , Mazur M , Reczuch K , Ponikowski P , Przewlocka-Kosmala M , Kosmala W 
Published: October 2022

Abstract

The predictors of favorable clinical response to aortic valve replacement (AVR) in aortic stenosis (AS) are still insufficiently defined. The increased LV afterload in AS affects the interpretation of the majority of LV systolic indices, which are load-dependent. The estimation of myocardial work (MW) is a newly developed approach, which, allowing correction of global longitudinal strain (GLS) for LV afterload, gives a more adequate insight into the intrinsic LV contractility.

Aim
To investigate whether the assessment of MW can improve the prediction of clinical and neurohormonal improvement post AVR in patients with AS.

Methods
We evaluated 126 patients (75±9 years) with severe AS who underwent transcatheter AVR (n=100) or surgical AVR (n=26). Transthoracic echocardiography, blood sampling and 6 min walk test (6MWT) were performed pre and 3 months post AVR. The following indices of MW were assessed: global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE).

Results
Post-AVR changes in the clinical and echocardiographic profile are presented in Table. Post-treatment increase in 6MWT distance was noted in 95 patients, and decrease in NT-proBNP in 94 patients. In multivariable analysis including clinical parameters and echocardiographic indices of cardiac function, morphology and aortic valve hemodynamic, baseline GWW was the only independent echocardiographic predictor of post-AVR improvement in 6MWT distance (beta=−0.24, SE 0.09, p=0.01), whereas baseline GWE was, in addition to tricuspid regurgitation pressure gradient (TRPG) and E/e' ratio, independently associated with the post-AVR decrease in NT-proBNP (beta=0.27, SE 0.09, p=0.004).

Conclusions
In patients with severe AS undergoing AVR, higher values of GWW do not favor post-treatment functional improvement as assessed by 6MWT. The beneficial neurohormonal response to AVR is more pronounced in patients with less efficient LV contraction at baseline.

Funding Acknowledgement
Type of funding sources: None.
Patient delay in acute myocardial infarction: a long journey still ahead
Authors: Marques C , Cabrita A , Maia Araujo P , Proenca T , Pinto R , Carvalho M , Costa C , Amador A F , Calvao J , Pinho A , Oliveira C , Santos L , Cruz C , Macedo F 
Published: October 2022

Abstract

Background
It is overly known that time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes.

Methods
In this six-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 194 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records.

Results
Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least one cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity ≥7 vs &lt;7 in a 0–10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. After this initial univariate analysis, multiple linear regression was performed to identify possible predictors of PD. Four variables were identified: pts ability to recognize their symptoms as AMI (β −0.199; 95% CI: −277 to −34,87; p=0.012), living in a non-rural residence (β 0.154; 95% CI: 0.12–161.44; p=0.05), presenting associated symptoms (β −0.194; 95% CI: −257.43 to −28.84; p=0.014) and occurrence of symptoms on weekdays (β 0.170; 95% CI: 12.73–259.49; p=0.031) predicted shorter patient delays.

Conclusion
Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts living in rural areas, in order to: 1) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 2) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”.

Funding Acknowledgement
Type of funding sources: None.
Socioeconomic status and waiting time in the emergency department for patients with chest pain
Authors: Herlitz S , Svensson P , Ohm J , Ekelund U , Habel H 
Published: October 2022

Abstract

Introduction
Acute coronary syndrome (ACS) is one of the leading causes of death in the world and timeliness of treatment and diagnosis is of utmost importance to reduce mortality and morbidity. Emergency department (ED) crowding results in longer waiting times and length of stay in the ED and is a globally growing phenomenon with clear negative consequences for patients. Low socioeconomic status (SES) has previously been associated with poor prognosis after ACS, but it remains unclear if treatment and diagnostics in the acute state is a contributing factor. ED length of stay has been linked to crowding and poor patient outcomes whereas mechanisms for generally worse prognosis in low SES remains poorly understood.

Purpose
To investigate whether SES, measured as disposable income, is associated with ED waiting times among patients with the most common chief complaint in ACS, chest pain.

Methods
A registry-based cohort study on all 140,388 patients arriving at 14 Swedish emergency departments between 2015 and 2019 with chest pain as their chief complaint registered in the Swedish Emergency Registry (SVAR). Individual-level sociodemographic and clinical data were linked from multiple national registries. The associations between disposable income quintiles and ED length of stay and time to doctor were assessed using multivariable regression models adjusting for age, sex, education, comorbidities (diabetes, hypertension, hyperlipidemia, obesity and cardiovascular disease) and ED-visit characteristics (arrival mode, triage level, arrival time (day, evening or night as well as weekday or weekend) and hospital type).

Results
Median length of stay was 11 minutes (4.4%) longer among patients in the lowest income quintile, 4:04 [hours:minutes] (95% confidence interval [CI] 4:02–4:05), compared to patients in the highest income quintile (3:53, 95% CI 3:52–3:55). Similarly, time to doctor was 6 min (8.7%) longer among patients in the lowest income quintile (1:15 min, 95% CI 1:14–1:16) than patients in the highest income quintile (1:09, 95% CI 1:08–1:10). The associations were independent of adjustment for studied confounders and mediators.

Conclusions
Among ED chest pain patients, low income was associated with longer length of stay and time to doctor which may impact negatively on patients with serious cardiovascular diagnosis such as ACS. Longer waiting times may delay diagnosis and timely treatment for the individual patient such as anti-ischemic and antithrombotic therapy.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Supported by grants provided by Region Stockholm (ALF-project)
Prevalence of illicit drugs use and association with in-hospital major adverse events in patients hospitalised for acute cardiac events: the ADDICT-ICCU Trial
Authors: Pezel T , Dillinger J G , Trimaille A , Delmas C , Piliero N , Bouleti C , Pommier T , El Ouahidi A , Andrieu S , Lattuca B , Rossanaly Vasram R , Fard D , Noirclerc N , Vicaut E , Henry P 
Published: October 2022

Abstract

Background
The prevalence and short-term cardiovascular consequences of illicit drug use in patients admitted to the intensive cardiac care unit (ICCU) for acute cardiovascular events are not well established.

Purpose
The Addiction in Intensive Cardiac Care Units (ADDICT-ICCU) study was designed to assess prospectively the prevalence of illicit drugs use, and their association with the occurrence of in-hospital major adverse events (MAEs) in consecutive patients admitted to ICCUs for acute cardiovascular events.

Methods
From 7 to 22 April 2021, screening for illicit drug was performed by systematic urinary testing in a prospective study including all consecutive patients admitted to ICCU in 39 centres throughout France. The primary outcome was the prevalence of the illicit drugs detected. The secondary clinical outcome was in-hospital Major Adverse cardiac Events (MAEs) defined by death, resuscitated cardiac arrest or cardiogenic shock.

Results
Among 1,499 consecutive patients screened (age 63.3±14.9 years, 69.6% male), 161 (10.7%) had a positive test for illicit drugs (cannabis: 9.1%, opioids: 2.1%, cocaine: 1.7%, amphetamines: 0.7%, 3,4-methylenedioxymethamphetamine: 0.6%). Patients who used illicit drugs were young (33.0% at age &lt;40 vs. 5.9% at age ≥60 years), and more frequently male (11.9% vs. 8.1%, p&lt;0.001). Self-reported current use was 56.5% in patients with a positive test. After a median duration of hospitalisation of five days, there were 61 in-hospital MAEs (4.1%).
The detection of illicit drugs was associated with a higher rate of MAEs after adjustment for known predictors of severity (OR=8.84; 95% CI: 4.68–16.7, p&lt;0.001) or after using a propensity score adjustment (OR=5.81; 95% CI: 4.14–8.14, p&lt;0.001). After adjustment for age and sex, detection of cannabis or cocaine was significantly associated with MAEs (OR=3.53; 95% CI: 1.25–9.95, p&lt;0.001; OR=5.12; 95% CI: 1.48–17.2, p=0.004 respectively). Multiple drug detection (28% of positive patients) was associated with a higher incidence of MAEs than single drug detection.

Conclusions
The prevalence of illicit drugs use in patients hospitalised in the ICCUs for acute cardiovascular events was 10.7% and was under-reported. Illicit drugs detection was independently associated with a higher occurrence of in-hospital MAEs.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fondation Coeur et Recherche
Targeted metabolomics in Out-of-Hospital Cardiac arrest (OHCA)
Authors: Paulin Beske R , Henriksen H H , Obling L O , Kjaergaard J K , Jeppesen J B J , Nielsen N , Johansson P J , Hassager C H 
Published: October 2022

Abstract

Background
Out-of-hospital cardiac arrest is a leading cause of death. Even if successfully resuscitated, mortality and morbidity remain high due to ischemic and reperfusion injury (I/R). The oxygen deprivation leads to a metabolic derangement amplified upon reperfusion resulting in an uncontrolled generation of reactive oxygen species, triggering cell death mechanisms and organ damage. Understanding the I/R damage in humans following OHCA remains sparse, with no existing treatment to attenuate the reperfusion injury.

Aim
Describe metabolic derangement in patients following OHCA.

Methods
Blood samples from consecutive resuscitated unconscious OHCA patients drawn at hospital admission were analyzed using ultra-performance liquid mass-spectrometry. Sixty-one metabolites of the ∼3000 compounds detected were prespecified for quantification and analyzed in the current study. We used hierarchical cluster data analysis to identify metabolic clusters/phenotypes.

Results
In total, 163 patients were included, of which 143 (88%) were men, and the median age was 62 years (53–68). All measured metabolites from the tricarboxylic (TCA) cycle were significantly higher in non-survivors vs. survivors (180-days survival). Hierarchical clustering identified four (A-D) phenotypes of patients with distinct metabolic profiles. The mortality was significantly different in two phenotypes; A and B (A: 62% and B: 59% vs. C: 21% and D: 24%, p&lt;0.001). There were no significant differences in age between the four phenotypes (p=0.35). Phenotype A and B had longer time to ROSC (A: 33 min (21–43), B: 27 min (24–35), C: 18 min (13–28), and D: 18 min (12–25), p&lt;0.001). Phenotype A and D, who both had higher levels of free fatty acids, also a higher prevalence of ST-elevation or acute left bundle branch block in first ECG as compared to phenotype B and C (A: 76%, B: 55%, C: 36% and D: 75%, p&lt;0.001.

Conclusion
Circulating levels of metabolites from the TCA cycle best described the variance between survivors and non-survivors. Four different metabolic phenotypes were identified. These phenotypes had significantly different mortality.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Novo Nordisk Foundation
First sampled plasma troponin T is associated with one-year mortality in sepsis and septic shock, independent of age, gender, comorbidities, and clinically relevant biomarkers
Authors: Loerstad S , Shekarestan S , Tehrani S , Jernberg T , Astrand P , Gille-Johnson P , Persson J 
Published: October 2022

Abstract

Background
Patients with sepsis and septic shock often have elevated troponin T levels indicating acute myocardial injury. Studies investigating the relationship between troponin T levels as a predictor for mortality in sepsis have been contradictory.

Purpose
To investigate if the first in-hospital sampled plasma troponin T value is associated with one-year mortality in sepsis and septic shock independent of comorbidities, Sequential Organ Failure Assessment (SOFA)-score, Clinical Frailty Scale, Charlson Comorbidity Index (including age) and clinical biomarkers (e.g., serum lactate, creatinine, C-reactive protein).

Methods
Patients with sepsis and sepsis shock were included if they were admitted to the intermediate and intensive care units at our institution between 1st of March 2012 and 30th of September 2021, and if at least one troponin T value was recorded within the first two calendar days from symptom onset. Variables were collected from medical records. Normal troponin-T was defined as &lt;15 ng/L. Elevated troponin T values were divided into quartiles (Q): Q1 15–35.9 ng/L, Q2 36–61.9 ng/L, Q3 62–125.9 ng/L and Q4 ≥126 ng/L. Kaplan-Meier stratified survival curves were plotted for normal levels and Qs of elevated troponin T. Multivariate Cox regression was used for multivariate analysis.

Results
586 patients were included and 529 (90%) had a first sampled troponin T ≥15 ng/L. 523 (89%) met the Sepsis-3 criteria for septic shock, the remainder met the criteria for sepsis. The mean age was 71 years and 220 (38%) were women. One-year mortality was 45% (n=264). Increasing levels of first sampled plasma troponin T were associated with higher hazard ratios (HR) for one-year mortality compared to normal levels (&lt;15 ng/L): Q1 HR 5.29 (95% confidence interval [CI] 1.9–14.7); Q2 HR 7.47 (95% CI 2.71–20.6); Q3 HR 12.81 (95% CI 4.7–35.0); Q 4 HR 13.82 (95% CI 5.06–37.7) (Figure 1). Troponin T was independently associated with one-year mortality after adjustment for gender, plasma lactate, plasma CRP, prior atrial fibrillation, in-hospital onset atrial fibrillation, SOFA-score, CFS, and CCI (including age) (Table 1).

Conclusions
Elevated first sampled plasma troponin T in patients with sepsis and septic shock was associated with higher one-year mortality, independent of age, gender, comorbidities, and clinically relevant biomarkers. There was a risk gradient across the Qs of elevated troponin T with increasingly higher risk of death at one year per higher Q. Further studies are needed to ascertain whether elevated troponin T levels and clinical assessment scores can be used together in the clinical setting to identify patients for more aggressive treatment and cardiac work-up.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Region Stockholm
Relationship between liver fibrosis and in-hospital outcomes in patients with acute coronary syndrome undergoing PCI
Authors: Biccire F G , Barilla F , Sammartini E , Dacierno E M , Tanzilli G , Pastori D 
Published: October 2022

Abstract

Background
Patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) still experience a high rate of in-hospital complications. Liver fibrosis (LF) is a risk factor for mortality in the general population. However its prognostic role in ACS patients has been poorly investigated.

Purpose
We investigated whether the presence of LF detected by the validated fibrosis-4 (FIB-4) score may indicate ACS patients at higher risk of poor outcome.

Methods
In the prospective ongoing REAl-world observationaL rEgistry of Acute Coronary Syndrome (REALE-ACS), LF was defined by a FIB-4 score &gt;3.25. The primary endpoint was in-hospital adverse events (AEs) including a composite of in-hospital cardiogenic shock, PEA/asystole, acute pulmonary edema and death.

Results
A total of 469 consecutive ACS consecutive patients were enrolled. Overall, 21.1% of patients had a FIB-4 score &gt;3.25. Patients with LF were older, less frequently on P2Y12 inhibitors (p=0.021) and admitted with higher serum levels of white blood cells (p&lt;0.001), neutrophils to lymphocytes ratio (p&lt;0.001), C-reactive protein (p=0.013), high-sensitive troponin T (p&lt;0.001), creatin-kinase MB (p&lt;0.001), D-Dimer levels (p&lt;0.001). STEMI presentation and higher Killip class/GRACE score were more common in the LF group (p&lt;0.001). 71 patients experienced 110 AEs. At the multivariate analysis including clinical and laboratory risk factors, FIB-4 &gt;3.25 (OR 3.1, 95% CI 1.4 to 6.9), admission left ventricular ejection fraction% below median (OR 9.2, 95% CI 3.9 to 21.7) and Killip class ≥II (OR 6.3, 95% CI 2.2 to 18.4) were the strongest independent predictors of in-hospital AEs.

Conclusions
LF detected by FIB-4 score &gt;3.25 was associated with more severe ACS presentation and worse in-hospital AEs irrespective of clinical and laboratory variables.

Funding Acknowledgement
Type of funding sources: None.
The influence of hemolysis upon admission on the performance of neuron-specific enolase in predicting death after resuscitated out-of-hospital cardiac arrest – a substudy of the IMICA trial
Authors: Abdi Isse Y , Wiberg S , Grand J , Obling L , Frikke-Schmidt R , Kjaergaard J , Hassager C , Meyer M A S 
Published: October 2022

Abstract

Background
The predominant cause of mortality among out-of-hospital cardiac arrest (OHCA) patients admitted to the intensive care unit in a comatose state is hypoxic-ischemic brain injury and consequent withdrawal of life sustaining therapies. Current guideline for post-resuscitation care suggests a multimodal approach for neuroprognostication including measuring a blood-born biomarker of neuronal injury termed neuron-specific enolase (NSE). However, NSE is also present in erythrocytes and therefore hemolysis – which frequently occurs immediately after resuscitation – must be assessed by measuring free-hemoglobin (free-hgb), and samples discarded if the threshold index is surpassed to minimize false positive results. In addition, the plasma half-life of NSE is much longer than free-hgb, and hemolysis occurring prior to the sampling point of NSE measurement, may cause elevated NSE levels due to destruction of erythrocytes rather than neurons, although free-hgb is no longer detectable in plasma.

Purpose
To investigate the relationship between hemolysis at hospital admission and NSE measured at 48 hours, and to determine the influence of hemolysis on the clinical performance of NSE in predicting all-cause mortality in comatose OHCA patients.

Methods
Free-hgb was measured at admission (0h) to quantify hemolysis. NSE was measured at 48 hours after admission. In each NSE sample hemolysis index was measured and mathematically corrected according to standard laboratory procedure. The relationship between free-hgb at 0h and NSE at 48h was investigated by Pearson's correlation analysis. The area under the receiver operating characteristic curves (AUROC) for prediction of all-cause mortality at 30 days were determined for both NSE and free-hgb, and the difference in AUROC between the two was calculated. Further, the positive and negative predictive values (PPV and NPV respectively) of NSE with a cut-off value at &gt;60 μg/l (as recommended by guidelines) in predicting all-cause mortality were calculated.

Results
Admission free-hgb and NSE at 48 hours were available for 64 consecutive patients surviving beyond 48 hours. The 30-day mortality in this population was 33%. There was no correlation between free-hgb at 0h and NSE at 48h (r=0.13, p=0.30; Figure 1). The AUROC for NSE was 0.92 (Figure 2), and 0.59 for free-hgb at 0h. The PPV for NSE&gt;60 μg/l was 1.0 (1.0–1.0) and NPV 0.84 (0.74–0.94).

Conclusions
The performance of NSE at 48 hours for predicting all-cause mortality among out-of-hospital cardiac arrest patients was not influenced by the degree of hemolysis at the time of admission, and NSE at 48 hours had both high positive and negative predictive values irrespectively of early hemolysis.

Funding Acknowledgement
Type of funding sources: None.