bluuebunny/crossref_metadata_2025 huggingface dataset:
Serial shock severity assessment within seventy-two hours after diagnosis: a cardiogenic shock working group report
Authors: Ton V , Li S , John K , Li B , Zweck E , Kanwar M , Sinha S , Hernandez-Montfort J , Garan A R , Goodman R , Faugno A , Farr M , Hall S , Kataria R , Kapur N
Published: October 2024

Background

The Cardiogenic Shock Working Group-modified Society for Cardiovascular Angiography and Interventions (CSWG-SCAI) staging was developed to risk stratify cardiogenic shock (CS) severity. Data illustrating progressive changes in SCAI stages and outcomes are limited.

Purpose

We investigated serial changes in CSWG-SCAI stages and outcomes of patients presenting with myocardial infarction- (MI-CS) and heart failure-related (HF-CS) cardiogenic shock.

Methods

The multi-center CSWG registry was queried. CSWG-SCAI stages were computed at CS diagnosis (baseline, 0 hour) and subsequently at 24, 48, and 72 hours.

Results

A total of 3268 patients (57% HF-CS, 27% MI-CS) were included. On admission, CSWG-SCAI stage breakdown was: 593 (18.1%) B, 528 (16.2%) C, 1659 (50.8%) D, and 488 (14.9%) non-cardiac arrest stage E (Fig. A). At 24 hours, >50% of stages B and C patients worsened, but 86% of stage D patients stayed at stage D. Among stage E patients, 54% improved to stage D and 36% stayed at stage E by 24 hours. Minimal change in SCAI stages occurred beyond 24 hours. SCAI stage trajectories were similar between MI-CS and HF-CS groups. Notably, stage B patients who worsened to stage C had similar mortality to those remaining at stage C (25.9% vs. 15.8%, p=0.1). Stage B patients worsening to stage D also had similar mortality to stage C patients worsening to stage D (27.4% vs. 25%, p=0.6) (Fig. B). Stage B subjects who remained at stage B by 24 hours still had a 20% in-hospital mortality. Patients who presented in or progressed to stage E by 24 hours had the highest rates of mortality.

Conclusions

Most patients with CS changed SCAI stages within 24 hours from CS diagnosis. Stage B patients were at high risk of worsening shock severity by 24 hours, associated with excess mortality. Early CS recognition and serial assessment may improve risk stratification.
A practical risk score for prediction of 6-month mortality in patients with acute heart failure: CHAM2P2
Authors: Todd F , Wong C , Gogola L , Skyrme-Jones A , Ghosh A K , Garg P , Sammut E , Kunadian V , Mamas M , Dastidar A
Published: October 2024

Background

Admission with acute heart failure carries a poor prognosis. Multiple predictive risk scores exist in heart failure presentation, however the utility of these scores in acute heart failure setting among older adults is limited.

Aim

The purpose of this study was to develop a practical risk score to predict 6-month mortality in patients presenting with acute heart failure.

Methods

Between January-August 2020, 474 consecutive patients (mean age 80 ± 11 years) admitted with acute heart failure to a large tertiary hospital in the South-West of England were identified. Data was retrospectively collected on admission bloods, comorbidities, imaging, echocardiography and post discharge mortality. Prediction modelling with multivariate Cox regression was then used to identify clinically relevant predictors of six-month mortality. Continuous variables were dichotomised around the mean/median for simplification. Variables were assigned points proportional to hazard ratios on Cox regression.

Results

Mortality at six months was 34% (161/474). Cox regression identified five significant (p<0.05) predictors of mortality: C: Clinical Frailty Score>5, H: hospital stay >10 days, A: age >80yrs, M: malignancy (current or previous) history and P: NT pro-BNP>4500pg/ml. In our final model, malignancy and NT pro-BNP were assigned two points with the remainder being assigned one.

In total, 304 patients had data available to generate CHAM2P2 scores. Mortality increased sequentially from 16.0% in patients with CHAM2P2 0-2, 44.4% in patients with CHAM2P2 scores of 3-5 and 94.1% in patients with CHAM2P2 scores of 6 or 7 (log rank <0.01). AUC demonstrated good discriminatory value of the CHAM2P2 score in predicting six-month mortality (AUC 0.74).

Conclusion

The CHAM2P2 score is a readily available and simple tool to predict 6-month mortality in patients admitted with acute heart failure.
Clinical characteristics and outcomes of patients with takotsubo syndrome and dynamic left ventricular outflow tract obstruction
Authors: Di Vece D , Bellino M , Silverio A , Migliarino S , Bossone E , Scudiero F , Novo G , Cameli M , Cristiano M , Aleksova A , Vecchione C , Galasso G , Parodi G , Sinagra G , Citro R
Published: October 2024

Background

Left ventricular outflow tract obstruction (LVOTO) is recognized as a serious complication of Takotsubo syndrome (TTS). However, its impact on patient prognosis remains insufficiently investigated.

Purpose

This study aimed to assess clinical characteristics and short- and long-term outcomes of patients with TTS complicated by LVOTO.

Methods

Patients with TTS were enrolled from the Takotsubo Italian Network (TIN). The primary outcome was the composite of acute heart failure, cardiogenic shock, and mortality during hospitalization. Secondary outcomes included the single components of the primary outcome and the occurrence of death or TTS recurrence during follow-up.

Results

Overall, 881 patients were included in the study [median age 72.0 (63.0–78.0) years; 91.3% female], with LVOTO detected in 59 patients (6.7%). Low diastolic blood pressure, ST-segment elevation, and moderate-to-severe mitral regurgitation were independently associated with occurrence of LVOTO. Propensity score weighting regression analysis revealed a significant higher risk of the primary outcome (OR, 2.99; 95% CI, 2.22–4.02), acute heart failure (OR, 2.19; 95% CI, 1.59–3.02), cardiogenic shock (OR, 4.56; 95% CI, 3.07–6.78), and in-hospital mortality (OR, 2.42; 95% CI, 1.13–5.21) in patients with TTS complicated by LVOTO. No significant association between LVOTO and long-term mortality or TTS recurrence was observed during follow-up.

Conclusions

In this real-world evidence study, LVOTO was detected in about 7% of TTS patients and was associated with a significantly higher risk of adverse events during hospitalization, including mortality. Early detection of LVOTO can aid in prognostic assessment and guide therapeutic management in patients with TTS.
Long-term outcomes in hospitalized heart failure patients in China: results from the China National Heart Failure (CN-HF) registry study
Authors: Cui X T , Jin X J , Zhou J , Xu Y M , Wang Y Y , Sun A J , Fu M , Hu K , Zhou J M , Ge J B
Published: October 2024

Background

There is a paucity of data on the long-term outcomes of heart failure (HF) patients in China. We aimed to investigate the incidence of cardiovascular (CV) death or rehospitalization due to worsening HF (WHF) and other outcomes among different subtypes of patients with chronic HF in China.

Methods

Data from the China National HF registry (CN-HF) during the period 1 February 2013–31 October 2015 were analyzed. Patients were categorized into three groups based on their left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF, LVEF≤40%), HF with mildly reduced ejection fraction (HFmrEF, LVEF 41%–49%), and HF with preserved ejection fraction (HFpEF, LVEF≥50%). Rates and risk of CV death or HF rehospitalization and other outcomes including all-cause mortality in each group were calculated and compared.

Results

In total 7171 patients (mean age 69.6 years, 59.5% male) with HF were enrolled across 45 centers in China. At discharge, ACEIs/ARBs, β-blockers and MRA were prescribed in 57.3%, 50.8% and 54.5% HF patients totally. The overall incidence of the primary outcome (CV death or HF rehospitalization) was 8.9%, 16.1%, and 23.5% at 6, 12, and 24 months post-discharge, respectively. Significantly higher rates of the primary outcome, all-cause mortality, and HF re-hospitalization were observed in patients with HFrEF and HFmrEF compared with those with HFpEF at 6, 12, and 24 months (P < 0.05). The incidence of CV death was similar across all LVEF subgroups.

Conclusions

Compared to patients with HFpEF, incidence of death or rehospitalization were higher among patients with HFrEF or HFmrEF in China. Optimal follow-up and management of HF both inside and outside of the hospital should be highlighted and put into practice.Primary outcome according to LVEFAll-cause death and rehospitalization
Anthropometric measures and long-term mortality in heart failure with reduced ejection: debunking the obesity paradox
Authors: Butt J , Thune J J , Nielsen J C , Gustafsson F , Bruun N E , Eiskjaer H , Brandes A , Hassager C , Svendsen J H , Torp-Pedersen C , Schou M , Pehrson S , Packer M , Mcmurray J J V , Koeber L
Published: October 2024

Background

In patients with heart failure (HF), an "obesity-survival paradox" has been reported. Although body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist-to-height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton.

Purpose

To examine and compare the prognostic value of several alternative anthropometric measures with that of BMI in patients with non-ischemic HF with reduced ejection fraction (HFrEF) enrolled in the DANISH trial. Patients were eligible if they had non-ischemic HFEF, a left ventricular ejection fraction of <35%, New York Heart Association functional class II-III (IV if cardiac resynchronization therapy was planned), and elevated natriuretic peptides. The outcomes of interest were all-cause mortality and cardiovascular death. The association between anthropometric measures and all-cause death was examined with Cox regression models, adjusted for prognostic variables, including natriuretic peptides.

Results

Among 1,116 patients with non-ischemic HFrEF, there was no evidence for a BMI-related "obesity-survival paradox" during a median follow-up of 9.5 years (25th-75th percentile, 7.9-10.9 years). Indeed, compared to patients with a BMI 18.5-24.9 kg/m2 (N=363), those with a BMI >35 kg/m2 (N=91) had a significantly higher risk of all-cause death (HR 1.78 [95% CI 1.28-2.48]). Greater waist-to-height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all-cause death, with a HR of 2.11 (95% CI, 1.53-2.92) for the highest quintile (N=205) compared with the lowest quintile (N=196). In the minimally adjusted restricted cubic spline models, the association between adiposity and all-cause death was more apparent for waist-to-height ratio than for BMI. A similar pattern was seen for cardiovascular death (Figure).

Conclusion

In patients with HFrEF, there was no evidence for an "obesity-survival paradox". Indeed, there was a clear association between adiposity and higher long-term mortality, which appeared to be stronger for waist-to-height ratio than for BMI. There is a need to test the potential benefits of intentional weight loss in patients with HFrEF and obesity.
Blood plasma metabolites and heart failure risk: insights from Mendelian randomization analysis
Authors: Ma Z , Frey N , Rangrez A Y
Published: October 2024

Background

Heart failure remains a leading cause of mortality and disability worldwide. Blood plasma metabolites play a crucial role in influencing heart failure, yet they are subject to numerous confounding factors. Mendelian randomization analysis provides a powerful tool for assessing causal relationships between them.

Methods

We conducted a Mendelian randomization analysis using a meta-analysis comprising 115,150 heart failure cases (155,331 controls) and 1400 serum metabolites. Various methods including Inverse variance weighting (IVW), MR Egger, Weighted median, and Weighted mode were employed to estimate causal effects. Sensitivity analyses were conducted using Cochran’s Q test, MR Steiger test, leave-one-out analyses, funnel plot, and MR-PRESSO.

Results

Following rigorous selection, among the 1400 blood plasma metabolites, 71 metabolites including Sphingomyelin, Myristate, AMP to methionine ratio showed significant associations with increased risk of heart failure. Additionally, 40 metabolites including Glycine, octadecenedioylcarnitine (C18:1-DC), 1-palmitoyl-2-dihomo-linolenoyl-GPC (16:0/20:3n3 or 6) exhibited significant associations with decreased risk of heart failure.

Conclusion

Identified blood plasma metabolites provide crucial insights into screening and prevention strategies for heart failure. Further validation is warranted through animal models and large-scale cohorts.
Validation of a hand-held ultrasound device in the evaluation of aortic stenosis
Authors: Zubiaur Zamacola J , Margarida De Castro A , Perez Barquin R , Lozano Gonzalez M , Gutierrez Ruiz N , Alarcos H , Gonzalez Vilchez F , Ruisanchez Villar C , Serrano D , Cuesta Cosgaya J M , Coroas C , Munoz Prejigueiro L , Abia L , De La Torre J M , Vazquez De Prada J A
Published: October 2024

Introduction

Hand-held Ultrasound devices (HHUD) are increasingly used in routine clinical practice, although until recently they did not have continuous Doppler. There is no evidence on the usefulness of an HHUD for the assessment of aortic stenosis (AS) in real life.

Objective

To validate the use of a new HHUD device in a real-life scenario.

Material and methods

Observational, single-center and prospective study, including patients diagnosed with AS with a previous standard echocardiography. Patients were randomly recruited from a tertiary cardiac imaging laboratory. Immediately after the reference echocardiography performed by an imaging expert, a Cardiology trainee with ASE level II repeated the study blindly with an HHUD. Agreement between the two tests was evaluated by measuring the mean aortic valve gradient (mAG). An intraclass correlation coefficient (ICC) test, linear regression, and Bland-Altman test were performed to compare the two methods.

Results

101 patients were recruited. The reference test calculated a mAG of 29 mmHg (19.8 - 42.2) versus a mAG of 27.2 mmHg (16.2 - 43.9) in HHUD. The statistical analysis showed a good correlation between both tests (ICC: 0.87 (95% CI: 0.79 -0.94) and r=0.89 (95% CI: 0.85-0.94) (Figure). The Bland-Altman test showed a non-significant underestimation (1.61 ± 0.9 mmHg; p= 0.09). The HHUD classified 29 cases as severe or major AS compared to 31 in the reference test (kappa= 0.81; 95% CI: 0.68 - 0.94). The HHUD showed an excellent agreement for classification of AS in at least severe AS grade. The kappa analysis had a value of 0.81 (95% CI 0.68 – 0.94) with a global agreement of 92.1%. The positive predictive value was 89.6%. The negative predictive value was 93.1%. Sensitivity and specificity were 83.8% and 95.7%. The rest of the variables evaluated showed poorer agreement. In those patients with obesity, worse acoustic window, atrial fibrillation and critical AS, the agreement was worse.

Conclusions

The new HHUD evaluated by an operator with limited experience showed good agreement with the reference echocardiographic device in determining the mean aortic gradient.Central picture
Prognostic value of alveolar surfactant type-B in acute heart failure: a long-term comparative analysis vs NT-proBNP
Authors: Bonazzi C , Bursi F , Furlotti N , Nemola G , Novello G , Martin D , Caretti A , Guazzi M
Published: October 2024

Background

In heart failure (HF) biomarkers are an integral component of prognostic assessment. Natriuretic peptides are the gold standard, but they do not directly reflect lung vascular injury. Surfactant type B (Surf-B) is released by type 2 alveolar cells under pressure induced trauma, with few reports just addressing its plasmatic levels in stable chronic HF (CHF). Information on acute HF (AHF) is lacking.

Purpose

To clarify the prognostic value of Surf-B changes vs NT-proBNP levels after decongestion therapy and to compare their prognostic ability at 1-year follow-up.

Methods

Patients with acute pulmonary edema (APE) underwent a combined evaluation of Surf-B and NT-proBNP serum levels with quantification of B-lines at hospital admission (time 0), discharge (time 1) and at 1 year (time 2).

Results

54 patients (mean age 72.1 ± 11 years; mean LVEF 36% ± 13%; 65% men) were enrolled. At time 1, the average Surf-B, NT-proBNP and B-lines were significantly reduced compared to time 0 (p<0.0001). No correlation between Surf-B and NT-proBNP was observed either at time 0 (r=-0.21; p=0.12) or at time 1 (r=0.05; p=0.71).

Despite the significant decrease in Surf-B levels from time 0 to time 1, 18.5% of patients behaved as non-responders exhibiting no changes in Surf-B; conversely, only 5.5% did not show significant reduction in NT-proBNP, despite significant decongestion.

38 patients were followed up to time 2: of these, 13 (34%) reached the composite endpoint of death or hospitalization for HF. Surf-B measured at time 1 was a strong predictor of adverse outcome. Patients with Surf-B above median at discharge displayed a worse survival-free from HF hospitalization compared to the remainders (Log rank p=0.012) (Figure). Also, patients with Surf-B above median at discharge had a more than 4-fold increased risk of the composite endpoint (HR 4.5, 95%CI 1.4-20.2, p=0.023). Conversely, NT-proBNP at discharge was not significantly associated with HF-free survival (Log rank p=0.26) (Figure) and was not a significant predictor of the composite outcome (HR 1.9, 95%CI 0.6-9.3, p=0.25). At ROC analysis, discharge Surf-B levels showed a higher area under the curve (AUC=0.763, p=0.011) than NT-proBNP values (AUC=0.69, p=0.063).

Conclusions

These data suggest that Surf-B, an organ specific biomarker of lung injury, is highly sensitive to the effectiveness of decongestion therapy, outperforming NT-proBNP. Given the high rate of patients who do not improve their Surf-B levels over time, the reparative processes of alveolar break damage may dissociate from mere decongestion and cardiac healing in AHF.Figure:1yr Kaplan-Meier survival curves
Prognostic value of right ventricular-pulmonary arterial coupling indices in patients with moderate to severe mitral stenosis
Authors: Chan M W , Li T , Leow R , Poh K K , Yeo T C , Kong W , Sia C H
Published: October 2024

Background

Right ventricular-pulmonary arterial (RV-PA) coupling represents the relationship of RV contractility and RV afterload. The ability of RV to adapt to changes in RV afterload (i.e. increased pulmonary arterial (PA) loading) has prognostic implications in various cardiovascular diseases such as heart failure and pulmonary arterial hypertension. RV-PA uncoupling occurs when RV contractility cannot match RV afterload, resulting in right heart dysfunction. However, RV-PA coupling has not been investigated in mitral stenosis patients.

Purpose

To evaluate the prognostic significance of various non-invasive RV-PA coupling parameters (TAPSE/PASP and RVFWLS/PASP) in patients with moderate to severe mitral stenosis.

Methods

This was a single-center retrospective study of 237 patients with moderate or severe mitral stenosis enrolled between January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected. RV free wall longitudinal strain (RVFWLS) was subsequently analyzed using TOMTEC software. Echocardiography-derived RV-PA coupling parameters were collected, including TAPSE/PASP and RVFWLS/PASP. The primary endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). RV parameters were analyzed separately to avoid collinearity.

Results

A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%). The median follow-up duration was 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean TAPSE 18.29 ± 5.36 mm and mean RVFWLS was -23.60 ± 7.96 %. In separate multivariable Cox regression models after adjustment for age , sex and mitral stenosis severity, TAPSE/PASP ratio < 0.36mm/mmHg (HR 2.025 , 95% CI 1.395-2.939, p < 0.001 ) and RVFWLS/PASP ratio ≥ - 0.5%/mm Hg (HR 2.031 95% CI 1.404 – 2.938 , p< 0.001) remained independently associated with mortality , heart failure hospitalization and valve intervention.

Conclusion

TAPSE/PASP and RVFWLS/PASP were independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.
Changes in N-terminal pro b-type natriuretic peptide according to SGLT2 inhibitor utilization patterns in patients hospitalized for decompensated heart failure: a prospective cohort study
Authors: Fountoulakis P , Theofilis P , Sagris M , Oikonomou E , Siasos G , Halvatsiotis P , Tsioufis P , Aggeli C , Tsioufis K , Tousoulis D
Published: October 2024

Introduction

Sodium-glucose cotransporter-2 (SGLT2) inhibitors have found success in treating patients with chronic heart failure (HF) across the entire spectrum of left ventricular ejection fraction (EF). Their benefits may also extend to patients with acute HF decompensation, as they may aid effective decongestion.

Purpose

This study aims to present the various patterns in changes of N-terminal pro b-type natriuretic peptide (NT-proBNP) according to SGLT2 inhibitor use in patients hospitalized for acute HF decompensation.

Methods

In this prospective cohort study, we enrolled consecutive patients hospitalized for HF decompensation during a 4-month period in a cardiology department. Prior medical history and cardiovascular risk factors were recorded. The patterns in SGLT2 inhibitor use were noted and patients were classified into three groups; Group 1 (No SGLT2 inhibitor use/Discontinuation), Group 2 (Prior SGLT2 inhibitor use and continuation), and Group 2 (SGLT2i-naïve and initiation). Categorization according to left ventricular (EF) to HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) was also performed. Moreover, estimated glomerular filtration rate (eGFR) was used as an estimate of renal function.

Results

In this analysis, 159 patients were included (median age: 79 years old, male sex: 64.8%, median duration of hospitalization: 6 days). In this population, 67.9% of the patients were not receiving a SGLT2 inhibitor on admission. Concerning demographic and clinical variables (Figure 1), there were no major differences in age, sex distribution, history of diabetes mellitus, dyslipidemia, and atrial fibrillation, as well as in renal function. Group 2 patients had a lower prevalence of arterial hypertension compared to Group 3 (36.6% vs. 52.6%, p<0.05). Moving to the changes in NTproBNP (Figure 2), we observed that patients who did not use SGLT2 inhibitors and did not initiate them during hospitalization had negligible changes in NTproBNP, either as an absolute change (Group 1: 506 (8792) pg/ml vs. Group 2: -5610 (9461) pg/ml vs. Group 3: -3602 (4409) pg/ml, p=0.001) or as percentage change (Group 1: -2.1 (63.4) % vs. Group 2: -30.3 (39.0) % vs. Group 3: -38.3 (41.5) %, p=0.001), compared to the rest of the study population who were already taking SGLT2 inhibitors or initiated them during hospitalization.

Conclusion

In this study we found NTproBNP, a widely used biomarker of congestion and prognosis in HF, was significantly reduced in decompensated HF patients receiving SGLT2 inhibitors, with the greatest change being observed in those being treatment-naïve prior to admission. These findings further highlight the role of this drug class even in the acute phase of the disease.Figure 1Figure 2
Prognostic value of left atrial strain in patients with moderate to severe mitral stenosis
Authors: Chan M W , Li T , Leow R , Poh K K , Yeo T C , Kong W , Sia C H
Published: October 2024

Background

Mitral stenosis causes an inflow restriction during diastole and is characterized by an increase in left atrial (LA) pressure with reduced cardiac output. Pressure overload of the LA can lead to atrial fibrosis and remodeling, resulting in a loss of LA reservoir and compliance capacity that can lead to backward load on the pulmonary circulation. To date, there are limited studies evaluating the impact of LA strain on prognosis of mitral stenosis patients.

Purpose

The aim of this study was to assess the prognostic value of LA strain in patients with moderate to severe mitral stenosis using two-dimensional (2D) strain imaging.

Methods

This was a single-center retrospective study, 237 patients with moderate or severe mitral stenosis were enrolled from January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected, LA strain measurements with reference time point at end diastole for reservoir strain (LASr), conduit strain (LAScd) and contraction strain (LASct) were analyzed using TOMTEC software. The endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). All the LA parameters were analyzed separately to avoid collinearity.

Results

A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%) with median follow up duration is 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean left atrium volume index (LAVI) was 73.94 ± 55.46 ml/m2, mean for LASr, LAScd and LASct were 11.81 ± 8.89%, -6.19 ± 4.50%, and -5.58 ± 6.05% respectively. LASr with a cut-off < 15.8% was independently associated with the composite outcome of all-cause mortality, heart failure hospitalization and valve intervention on multivariable Cox regression analysis (HR 2.51, 95% CI 1.54 - 4.10, p < 0.001). LAScd, LASct and LA volume index did not demonstrate any significant association with the endpoint.

Conclusion

LASr was independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.
TAVI for treating severe aortic valve disease in cardiogenic shock: a single centre experience
Authors: Sobral Domingues M , Certo Pereira J , Carvalho R , Presume J , Brizido C , Strong C , Gabriel H , Raposo L , Goncalves P , Almeida M , Tralhao A , Campante Teles R
Published: October 2024

Introduction

Recent evidence shows the safety and efficacy of TAVI in patients with aortic valve disease (AVD) presenting in cardiogenic shock (CS). However, there is limited data regarding CS management in the cardiac intensive care unit (CICU) and its outcomes. We aimed to describe the CS features, pre-TAVI management and short-term clinical outcomes of a cohort of CS patients (pts) submitted to TAVI.

Methods

Single-centre retrospective registry of consecutive pts with AVD undergoing TAVI in CS, from January 2020 to October 2023. CS was defined as pre-procedural hypotension/hypoperfusion requiring vasoactive drugs or mechanical circulatory support (MCS) devices. The severity of CS was defined according to the SCAI classification. Procedural related outcomes according to the VARC-3 criteria and 30-day mortality were assessed.

Results

A total of 16 pts (1% of our global TAVI cohort, 62% male, mean age 79±5 years) meet the inclusion criteria. The majority (n=13) presented severe aortic stenosis, two had degenerated aortic bioprosthesis with severe regurgitation and one had native valve severe regurgitation. 6 pts (38%) had isolated left ventricle (LV) dysfunction and 10 (62%) had biventricular dysfunction. The admission LVEF was 33±8% and the mean transaortic gradient for those with aortic stenosis was 46±13mmHg. The EuroSCORE II estimated for a single non-CABG emergency procedure was 37±15%. All patients were refused for surgical treatment upon Heart Team discussion.

At admission, 12 (75%) patients presented in CS SCAI-C, 1 (6%) in SCAI-D and 3 (19%) in SCAI-E. These last 3 patients presented in cardiac arrest upon admission to the CICU (time to ROSC from 2 to 15 minutes). The peak lactate level at 48 hours was 3.4 mmol/L [2.1-5.1] and the highest Vasoactive-Inotropic Score (VIS) during admission was 21 [11-45]. None of the patients needed MCS pre-TAVI. 5 (31%) patients required invasive mechanical ventilation and 5 (31%) renal replacement therapy.

Median time between CICU admission and transfemoral TAVI was 2.5 days [IQR 1-7].

Procedural success was 100%, with 57% receiving a balloon-expandable and 43% a self-expandable valve. Post-TAVI CICU length of stay was 6 days [IQR 5-9]. Most common procedural complication were the need for permanent pacemaker implantation (n=2, 12%) and access-related bleeding (n=2, 12%). Hospital length-of-stay was 20±15 days. Thirty-day mortality was 12% (n=2).

Conclusion

In this cohort of CS patients selected for TAVI treatment, procedural success was achieved in all cases. While complications were similar to the general TAVI population, in-hospital mortality remained high but very acceptable. These results suggest that, if correctly selected, aortic valve disease patients in CS represent a niche for whom brief stabilization and urgent percutaneous valve treatment might impact their dismal prognosis.
Predicting heart failure in cancer survivors: use of polygenic risk vs clinical score
Authors: Soh C , Xiang R , Takeuchi F , Marwick T
Published: October 2024

Background

The risk of heart failure (HF) is increased among cancer survivors, but predicting individual HF risk is difficult. Polygenic risk scores (PRS) for HF prediction summarize the combined effect of multiple genetic variants, specific to the individual. We sought to compare clinical HF prediction models with PRS in both cancer- and non-cancer populations.

Methods

Cancer and HF diagnoses were identified in the UK-Biobank from International Classification of Diseases (ICD)-10 codes. HF risk was calculated using the Atherosclerosis Risk in Communities score (ARIC-HF). PRS-HF was calculated using the Global Biobank Meta-analysis Initiative. The predictive performance of ARIC-HF and PRS-HF were compared using the area under the curve (AUC) in both cancer- and non-cancer populations.

Results

After excluding 2,644 participants with HF prior to consent, we identified 440,813 non-cancer participants (mean age 57 years, 53% female) and 43,720 cancer survivors (mean age 60 years, 65% female). Both ARIC-HF and PRS-HF were significant predictors for HF occurrence after adjustment for chronic kidney disease, overall health rating and total cholesterol level. The PRS-HF performed poorly in predicting HF among cancer (AUC: 0.552) and non-cancer populations (AUC: 0.571). However, the ARIC-HF predicted HF incidence in the non-cancer population (AUC: 0.806) and a reasonable performance among the cancer population (AUC: 0.748).

Conclusions

Prediction of HF occurrence in cancer survivors based on conventional risk factors is superior to PRS. However, both models demonstrate suboptimal discriminative capabilities in forecasting HF, emphasizing the imperative for the development of a cancer-specific HF predictive model.
Safety of COVID-19 vaccines regarding cardiovascular events: a systematic review and meta-analysis
Authors: Ramandi A , Behnoush A H , Khaheshi I
Published: October 2024

Background

Since the outbreak of COVID-19, extensive vaccination strategies have almost excelled in reducing the mortality and severity of COVID-19 infection; however, although there are several authorized vaccines thus far, vaccine hesitancy has risen among various populations. Cardiovascular adverse events have been among the highly reported adverse events of the vaccines. Herein, we aimed to systematically assess the studies that reported the safety of COVID-19 outcomes regarding cardiovascular outcomes.

Methods

Three online databases were comprehensively searched, including PubMed, Scopus, and Embase. Relevant observational/interventional studies and case reports/series were included. Study characteristics, demographic features of the populations, vaccine type and dosage, and outcomes of interest were extracted. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated to compare the groups vaccinated and those that have not.

Results

From the 2960 initial searched records, 21 observational/interventional studies, and 110 case reports/series were included. Meta-analysis revealed that there is no difference between vaccinated and non-vaccinated regarding all new-onset cardiac disorders (RR 1.14, 95% CI 0.71 to 1.85, p-value=0.59). On the other hand, vaccinated patients had a higher risk of myopericarditis, compared to the general population by 74% (RR 1.74, 95% CI 1.56 to 1.94, p-value <0.01). There was no difference between the groups in terms of risk of myocardial infarction. Among 219 individuals reported in case reports and series, 193 were diagnosed with myocarditis and pericarditis. Notably, 95.34% of these patients were vaccinated with mRNA-based vaccines.

Conclusion

This systematic review and meta-analysis implied that there is no increase in overall new-onset cardiac adverse events, while there might be an increased risk of myopericarditis based on some studies’ findings. This highlights that since there is no added cardiovascular risk associated with COVID-19 vaccination, all individuals are encouraged to get vaccinated.Forest plots for meta-analyses
Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock
Authors: Dettling A , Kellner C , Sundermeyer J , Blankenberg S , Kirchhof P , Luedike P , Nordbeck P , Tavazzi G , Proudfoot A , Thiele H , Eitel I , Pauschinger M , Westermann D , Schrage B , Manger N
Published: October 2024

Background

Mortality in cardiogenic shock (CS) remains high even when mechanical circulatory support (MCS) restores adequate circulation. Despite extensive research efforts in recent years, evidence on MCS in this setting is so far neutral. Especially, weaning from MCS is a challenging aspect of daily MCS management and standardized guidance is not yet available.

Purpose

This study aims to investigate incidence and predictors of weaning failure from venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with CS.

Methods

Patients with CS treated with VA-ECMO at 23 tertiary-care centres in 7 countries were analysed. Weaning failure was defined as death during VA-ECMO support and death within two days after VA-ECMO explantation. To evaluate whether patient or treatment specific characteristics could serve as predictors for weaning success or failure multivariable logistic regressions models were fitted.

Results

A total of 685 patients with CS treated with VA-ECMO were included in this study. Median age was 57 (49-66) years and 542 (77.1%) were male. More than half of the patients presented with CS due to acute myocardial infarction (AMI) (n=438, 63.9%) and prior cardiac arrest (n=431, 62.9%). Median lactate upon admission was 7.6 mmol/l (4.1-12.7). Of these, 410 patients (59.9%) were successfully weaned from VA-ECMO, whereas in 275 patients (40.1%) weaning failed. Of the successfully weaned patients 162 (39.5%) died before hospital discharge. The mortality of the overall cohort was 63.8%. AMI was slightly less common in patients with failed weaning. Age (Odds ratio (OR) 1.04, 95% confidence interval (CI): 1.02, 1.06; p<0.001) and cardiac arrest before VA-ECMO implantation (OR 1.68, 95%-CI: 1.09, 2.6; p=0.019) where the only baseline parameters associated with weaning failure. Lactate clearance within 24h after VA-ECMO initiation was associated with successful weaning (OR 0.13, 95%-CI: 0.07, 0.26; p<0.001, Figure 1).

Conclusion

VA-ECMO weaning is common and fails in 40% of patients in whom it is attempted. 60% of patients are discharged alive after a successful VA-ECMO weaning attempt. Older age, cardiac arrest, and slow clearing of lactate are predictors of failed ECMO weaning. These data illustrate the complex factors contributing to successful mechanical circulatory support.Figure 1
Predictors of heart failure hospitalization after surgery in patients with primary mitral regurgitation: the relevance of left atrial coupling index
Authors: O'neill Gonzalez P , Islas F , Carnero M , Parraga R , Perez-Camargo D , Montero L , Mahia P , Gil-Abizanda S , De Agustin J A , Olmos C
Published: October 2024

Background and Aims

The main indications for surgery in patients with primary mitral regurgitation (PMR) include the presence of symptoms, left ventricular dysfunction (LVEF ≤60%) and dilation (LVESD ≥ 40 mm), but novel markers are needed to detect early myocardial damage. Our aim was to explore the impact of echocardiographic parameters on the incidence of heart failure (HF) hospitalizations after surgery in our cohort of patients with PMR.

Methods

Retrospective analysis of a prospective cohort of patients with PMR who underwent mitral valve surgery in a tertiary care center from 2014 to 2022.

Echocardiographic parameters measured prior to surgery were analyzed. The primary outcome was HF admissions during follow-up.

Results

349 patients were included. The mean age was 69 (12) years and 55.9% were male. During a mean follow up of 3.28 (2) years, 13 patients (3.7%) were admitted due to HF.

Variables significantly associated with HF admissions were: female gender, atrial fibrillation prior to surgery, LVEF, LV end-diastolic volume index, LV global longitudinal strain, left atrial coupling index [LACI] (end-diastolic left atrial volume/end-diastolic LV volume), TAPSE and right ventricular-arterial coupling.

In a multivariable logistic regression analysis, the only independent predictors of HF admissions were female gender (OR 5.68), LVEF (OR 0.93) and LACI (1.87) (p<0.05).

Conclusions

In our cohort of patients with PMR, apart from LVEF, LACI was the only echocardiographic parameter independently associated with HF hospitalizations after surgery. This easy to obtain echocardiographic parameter, which takes into account the interrelation between LA and LV compliance, could help guide patients’ management in this setting.Table 1
LA reservoir strain predicts elevated left atrial pressure in patients with Veno-Arterial (VA) extracorporeal membrane oxygenator (ECMO) support for cardiogenic shock
Authors: Puwanant S , Srimahachota S S , Osotthanakorn T O , Bhumitrakul J B , Athisakul S A , Lertsuwunseri V L , Wanlapakorn C W , Limjaroen T L , Tinakorn Na Ayudhya C T , Ariyachaipanich A A , Sinphurmsukskul S S , Siwamogsatham S S
Published: October 2024

Background

Veno-arterial (VA) extracorporeal membrane oxygenator (ECMO) is not a left ventricular (LV) support system as it increases aortic pressure and LV afterload due to retrograde blood flow in the aorta. This can lead to complications such as increased LV volume (LV distention), increased LV and left atrial (LA) pressures, and pulmonary edema. We sought to investigate the correlation between LA strain and invasive LA pressure (LAP) in patients with ECMO support for cardiogenic shock undergoing atrial septostomy with stenting.

Methods and Results

A total of 24 consecutive patients (52±20 years; 83% were male) undergoing atrial septostomy with stenting while being on ECMO support for cardiogenic shock for left heart decompression were analyzed. LAP was measured immediately after transeptal puncture and before deployment of interatrial septal stent. A comprehensive echocardiogram was performed in all patients prior to atrial septostomy. Median time difference between echocardiogram and LAP measurement was 3.5 (0.5-20) hours. LA strain analysis was performed using the TomTec Arena 2D-cardiac performance analysis (CPA) software. LA reservoir strain was measured at peak systole during the reservoir phase in a single apical 4-chamber view. Intraclass correlation coefficients between 2 different investigators were excellent (All> 0.95). Median LA reservoir strain and LAP were 3.2 (0.5-1) % and 23 (8-53) mmHg, respectively. LA reservoir strain significantly correlated with LAP (r=0.53, p=0.034). LA reservoir strain of < 1.5% can effectively predict markedly elevated LAP (LA> 30 mmHg) (OR =9.9, p =0.0016).

Conclusions

LA reservoir strain significantly correlated with invasive LAP. With the advent of strain imaging software, LA reservoir strain is a feasible, reproducible, noninvasive, and straightforward method to predict the need for left heart decompression and/or to guide optimal afterload management in patients with VA-ECMO for cardiogenic shock. Further a prospective simultaneous echocardiographic and invasive LAP study is needed.
The impact of type 2 diabetes on short term myocardial morphological, functional, and energetic recovery post coronary artery bypass surgery in patients with ischemic heart disease
Authors: Kotha S , Giannoudi M , Procter H , Jex N , Chowdhary A , Thirunavukarasu S , Swoboda P , Plein S , Greenwood J P , Valkovic L , Kellman P , Levelt E
Published: October 2024

Background

Type 2 diabetes (T2D) confers three times higher mortality in patients with ischemic heart disease (IHD). Moreover, amongst patients with IHD those with diabetes were shown to have higher long-term mortality from heart failure despite angiographic or surgical revascularisation with coronary artery bypass grafting (CABG). Impaired myocardial structural, functional, and energetic recovery may underpin this epidemiological observation. Consequently, using cardiovascular magnetic resonance and phosphorus-magnetic resonance spectroscopy scans, we aimed to assess the effect of T2D comorbidity on myocardial structural, functional, perfusion, and energetic recovery post-CABG in patients with IHD.

Methods

Seventy-seven IHD patients with (n=39) and without T2D (n=38) awaiting CABG were recruited. One-month pre- and 6-months post-CABG, cardiac phosphocreatine to ATP ratio (PCr/ATP), global longitudinal shortening (GLS) and 6-minute walk-distance (6MWD) were assessed in the study cohorts. The rest and adenosine-stress myocardial blood flow (MBF) assessments were only performed 6-months post-CABG.

Results

Pre-CABG, IHD-T2D patients had higher LV concentricity (LV mass to LV end diastolic volume ratio) (IHD-T2D:0.84[0.74,0.93],IHD-noT2D:0.72[0.67,0.77]g/mL,P=0.03]. worse PCr/ATP T2D (IHD-T2D:1.5[1.4,1.7],IHD-noT2D:1.8[1.6, 2.0];P=0.03) and shorter 6-minute walk distance (IHD-T2D:338[307,370],IHD-noT2D:399[364,434]m,P=0.007). There were no significant differences in LV volumes, ejection fraction or GLS between the two groups pre-CABG.

Post-CABG, there was no longer a significant difference in cardiac energetics or 6-minute walk distances between the two groups due to a significant improvement in PCr/ATP in the IHD-T2D group. LV concentricity remained significantly elevated in the IHD-T2D group post CABG (IHD-T2D:0.82[0.75,0.88],IHD-noT2D:0.73[0.68,0.79]g/mL,P=0.04). Neither group showed a significant change in LVEF or GLS from the pre-CABG values, and post-CABG there were no differences in the rest or stress myocardial blood flows between the two groups.

Conclusions

Six months after CABG, neither IHD patients with T2D, nor IHD patients without T2D show any significant changes in LV structural remodelling or in contractile function. T2D does not jeopardise the short-term recovery in myocardial energetics or exercise distance post-CABG, with IHD patients with T2D showing more pronounced improvements post-CABG in both these assessments than patients without T2D. Larger longitudinal studies are needed to better understand the mechanisms of adverse longer-term cardiovascular outcomes suggested by epidemiological studies in IHD patients with T2D.
Triglyceride-glucose index predicts the prognosis of patients with ischemic cardiomyopathy
Authors: Ziheng L , Yi S , Yi S , Zhang Y , Zhang Y
Published: October 2024

Objective

A large number of studies have provided strong statistical evidence that the Triglyceride-glucose (TYG) index is associated with the development and prognosis of cardiovascular disease. However, little is known about the predictive value of TYG index for ischemic cardiomyopathy (ICM). This study aimed to investigate the predictive value of TYG index in patients with ICM.

Methods

Hospitalized patients ICM in our Hospital from April 2014 to December 2017 were included in this study. Inclusion criteria: previous definite diagnosis of coronary atherosclerotic heart disease (coronary angiography found one or more vessels stenosis > 50%) and echocardiography showed LVEF < 45 percent. In addition, the TYG index was calculated as follows :LN[fasting triglycerides (mg /dl)× fasting blood glucose (mg /dl)x1/2]. The endpoint of the study was MACE events, including all-cause death, myocardial infarction, ischemia-induced revascularization and heart failure (HF) rehospitalization.

Results

A total of 688 patients were included in this study and followed up for 1 year. In the multivariate Cox proportional hazards model, TYG index (adjusted HR 2.33 [95% CI: 1.30-4.20], P<0.01) were associated with an increased risk of MACE events, and the area under the ROC curve (AUC) was 0.604 (95%CI: 0.528-0.680, p <0.05). A total of 197 ICM patients with previously diagnosed diabetes were screened for analysis. We found that TYG index (adjusted HR 6.63 [95% CI: 2.15-20.47], P<0.01), and the AUC was 0.691 (95%CI: 0.562-0.820, p<0.05).

Conclusion

TYG index can predict the poor prognosis of ICM patients, and the predictive value of TyG index for ICM patients with diabetes is more significant.