bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of intravenous iron-carbohydrate complexes in patients with heart failure with reduced ejection fraction and iron deficiency: a meta-analysis of randomized controlled trials
Authors: Kuno T O S H I K , Mototani R E N A , Watanabe A T S U Y U , Briasoulis A
Published: November 2023

Background

Iron deficiency (ID) has been associated with having the potential to cause heart failure as well as worsening heart failure with reduced ejection fraction (HFrEF). Treatment with a target on ID has been shown to lead to improvement in heart failure patient outcomes. In this study, we performed a meta-analysis of the RCTs to more comprehensively evaluate the effectiveness of intravenous iron-carbohydrate complexes in HF patients with ID.

Methods

We conducted a systematic literature search on MEDLINE and EMBASE. The search terms included "iron," "iron deficiency," "iron complex," "iron-carbohydrate," "iron sucrose," "heart failure," "HFrEF," and "intravenous." Included studies met the following criteria: (i) a study was published in a peer-reviewed journal; (ii) a study design was a randomized controlled trial; (iii) study enrolled patients with HFrEF and ID, and (iv) a study evaluated intravenous iron-carbohydrate complex. The primary outcome was all-cause mortality during the follow-up. The secondary outcomes were cardiovascular (CV) mortality (deaths due to CV causes), CV admission (hospitalizations due to cardiovascular causes), and HF admission (first hospitalizations due to HF or hospitalizations due to HF worsening). Risk ratios (RRs) with 95% confidence intervals (95%CIs) were calculated with the event/total number in each study and synthesized by a random-effects model.

Results

We identified 926 articles by the initial database search and additional manual search and retrieved the full text of 18 articles for further review. We then excluded 3 sub-analyses of the included trials to avoid patients’ duplications. Finally, we included 15 RCTs with a total of 3,085 patients (the median or mean age, 62–75 years; female, 25-55%; median follow-up duration, 2–141 weeks). Intravenous iron-carbohydrate complexes were associated with lower risks of all-cause mortality, CV mortality, CV admission, and HF admission, though statistical significance was only observed in HF admission (Figure A-D). CV admission and HF admission provided substantial heterogeneity.

Conclusion

The results of this meta-analysis showed that intravenous iron-carbohydrate complex therapy in patients with HFrEF and ID was beneficial in lowering the risk of hospitalization due to heart failure. Physicians should be aware of the significance of ID when treating patients with HFrEF.
Impact of the role of cardiology pharmacy specialist on the improvement of quality indicators among patients with heart failure and reduced ejection fraction
Authors: Yaseen I , Farhan H A
Published: November 2023

Background

2021 European Society of Cardiology quality indicators (QIs) for the care and outcomes of adults contains a domain for patients with heart failure with reduced ejection fraction (HFrEF) for initial treatment of guideline-directed medical therapy (GDMT) which includes beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-neprilysin receptors inhibitors (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose transporter-2 inhibitor (SGLT2i). The QIs for the individual GDMT is estimated by finding the proportion of patients with HFrEF who are prescribed each therapy in the absence of any contraindication.

Purpose

To identify the role of the board certified cardiology pharmacist (BCCP) on improving the quality indicators regarding the prescribing of GDMT among patients with HFrEF during hospitalization and before discharge.

Methods

A cross-sectional study was conducted at the cardiac care unit in a single heart center in Iraq between January 2021 to February 2023. Among the multidisciplinary team member at this unit is a BCCP who suggests optimization of medical therapy based on the recommendations of updated European or American guidelines for the management of different cardiovascular diseases including HFrEF. The suggestion then discussed with the cardiologists for agreement. The study included the medical records for patients with HFrEF and BCCP interventions whether the interventions regarding GDMT or other medical therapy interventions. Data were reviewed and were analyzed to identify the specific interventions related to the initiation of one or more GDMT in each patients.

Results

Among 164 patients with HFrEF with BCCP interventions, there were 102 (62%) patients who were eligible for one or more of the GDMTs prescription which was suggested by BCCP. The most GDMT initiated was MRA 53 (43%) among 123 interventions and in 53 (52%) of 102 patients (Figure 1). QIs were improved (100%) for BB, ACEI/ARNI, MRA, and SGLT2i among eligible patients as shown in table 1.

Conclusions

The role of BCCP is essential among heart team for improving QIs related to the GDMT prescription among patients with HFrEF based on the recommendations of the updated guidelines. BCCP mainly improved the QIs for the prescription of MRA.Frequency of GDMT Initiation by BCCPGDMT Initiation Reflecting Improved QIs
The effects of cardiovascular rehabilitation in patients with heart failure with reduced ejection fraction - does gender really matter?
Authors: Stojanovic M , Deljanin Ilic M , Vukovic A , Stankovic M , Igrutinovic Novkovic J , Igic I
Published: November 2023

Background

The prevalence of heart failure (HF) in the adult population appears to be 1-2%, and it rises with age. About ½ of HF patients have reduced ejection fraction (HFrEF). Although the positive effects of cardiac rehabilitation (CR) in patients with HFrEF are well known, women seem to participate in CR significantly less compared to men.

Purpose

To determine whether there is a difference in the effects of CR on the tolerance of physical strain and the quality of life (QOL) related to gender in examinees with HFrEF.

Methods

The study involved 225 pts with HFrEF, 190 men (84.4%) and 35 women (15.56%), who were referred to a three-week CR program. At baseline and the end of CR exercise stress test (EST) was taken. The QOL was assessed at the beginning and the end of CR by validated questionnaire Short-Form 36.

Results

Male pts showed better strain tolerance on the first and the second EST compared to female pts. However, both gender showed improvement in physical strain tolerance on the second EST by achieving higher strain level (men 2.17±0.85 vs. 2.56±0.88, p=0.000; women 1.74±0.7 vs. 2.14±0.77, p=0.001), and longer duration of EST (men 2.56±2.97 vs. 5.64±2.85, p=0.000; women 2.28±2.46 vs. 4.63±2.4, p=0.000). Also, significantly more male and female pts achieved submaximal heart rate on the second EST (p=0.000 for men, and p=0.046 for women). Furthermore, CR has led to an improvement in the QOL in both men and women. Namely, all parameters were better at the end of CR, both in men and women. However, statistically significant improvements in female pts were noted in physical functioning (40±16.96 vs. 70±6.12, p=0.034), and energy/fatigue (43±17.54 vs. 62±20.49, p=0.041). On the other hand, the statistical significance in male pts was reached in physical functioning (59.38±25.57 vs. 67.23±23.47, p=0.002), energy/fatigue (60.43±22.7 vs. 64.08±21.22, p=0.036), emotional well-being (71.31±20.97, vs. 74.29±21.18, p=0.011), body pain (63.64±26.95 vs. 71.93±23.58, p=0.000), and general health (48.94±14.7 vs. 55.27±18.1, p=0.000).

Conclusion

Women generally less participate in CR than men. Results indicated that CR improves exercise capacity and QOL in HFrEF patients, in both men and women. This is why CR needs improvement in the referral and participation of women.
Left atrial strain predicts fibrosis of left atrial appendage in patients with atrial fibrillation undergoing totally thoracoscopic ablation
Authors: Park S , Kim J H , Jeong D S , Chung S , Bak M J , Kim E K , Chang S A , Lee S C , Park S W
Published: November 2023

Background

Left atrial (LA) fibrosis is related with development and severity of atrial fibrillation (AF). The aim of this study was to investigated factors associated with LA fibrosis in patients undergoing totally thoracoscopic ablation (TTA) for AF.

Methods

Between February 2012 and March 2015, a total of 128 patients who underwent TTA were enrolled from a tertiary hospital. Left atrial appendage (LAA) was harvested during surgery to determine the degree of fibrosis. LAA fibrosis was classified as mild (1st quartile), moderate (2nd and 3rd quartile), or severe (4th quartile). Clinical outcome was 5-year recurrence rate of AF detected in electrocardiogram or 24-hour Holter monitoring.

Results

The mean age was 54.3 ± 8.8 years and 18.8% had paroxysmal AF. Patients with mild LAA fibrosis had a significantly lower rate of recurrent AF (23.3%) at 5 years after TTA compared with those with moderate (51.4%; hazard ratio [HR] 2.69; 95% confidence interval [CI] 1.19─6.12) or severe (53.2%; HR 2.84; 95% CI 1.16─6.97) fibrosis. Among clinical and echocardiographic parameters, peak LA strain was the only predictor of mild LAA fibrosis (coefficient 0.10, p=0.005) with the best cutoff value of 14.7% (area under the curve 0.732). The prevalence of mild LAA fibrosis was 40.6% in patients with peak LA strain ≥14.7%, but only 6.8% in those with peak LA strain <14.7%.

Conclusions

In patients undergoing thoracoscopic ablation for AF, mild LAA fibrosis was associated with a lower risk of 5-year AF recurrence. LA strain is the only predictor of mild LAA fibrosis that reflects a lower risk of 5-year AF recurrence.
Left bundle branch area pacing in patients with CRT indication: short-term results & 1-year follow-up
Authors: Kataria V , Bhagwati M O H I T , Yaduvanshi A , Kitey P R I T A M
Published: November 2023

Background

Cardiac resynchronization therapy (CRT) using bi-ventricular pacing is class I recommendation for symptomatic patients with heart failure (LVEF ≤35%), QRS duration ≥150 msec and LBBB QRS morphology. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. The aim of this study was to assess the feasibility and outcomes of LBBAP in patients eligible for CRT.

Methods

Patients with CRT indications were subjected to LBBAP. Peri-procedural outcomes & QRS duration were recorded. Changes in New York Heart Association (NYHA) class, need for HF hospitalization, echocardiographic data, lead-device parameters were evaluated at follow-up. HF status was assessed by clinical (no HF hospitalization and improvement in NYHA class) and echocardiographic response (≥5% improvement in LVEF).

Results

LBBAP was attempted in 16 patients (mean age 59.3 ±7.04 years, 37.5% women, ischemic cardiomyopathy in 33.3%). All patients had baseline LBBB. Pacing threshold and R-wave amplitudes were 0.8 ± 0.3 V at 0.5 ms and 12.1 ± 3.5 mV at implantation and remained stable during mean follow-up of 11.25 ± 3.7 (Range 6-18) months. LBBAP resulted in significant QRS narrowing from 147.5 ± 9.7 to 116 ± 10.2 ms (p < 0.01). LVEF improved from 28.2 ± 2.8% to 38.9 ± 5.1% (p < 0.01). Clinical and echocardiographic improvement was observed in 77% and 74% of patients, respectively.

Conclusions

LBBAP is feasible, safe and effective. It provides an alternative option for CRT. LBBAP provides low and stable pacing thresholds and is associated with improved clinical and echocardiographic outcomes.
Echocardiographic predictors of occult atrial fibrillation in patients with cryptogenic stroke
Authors: Kim P , Tao M , Gier C , Kemppainen C , Al-Sadawi M , Aslam F , Henriques M , Singh A , Almasry I , Dianati-Maleki N , Fan R , Rashba E , Kort S
Published: November 2023

Background

Left atrial (LA) strain has been proposed as an echocardiographic predictor of subsequent atrial fibrillation (AF) in patients presenting with cryptogenic stroke (CS). The purpose of this study was to compare the predictive value of LA strain parameters with traditional echocardiographic measurements for predicting occult AF in patients with CS.

Methods

We conducted a single-center retrospective cohort study of patients with cryptogenic stroke who underwent implantable cardiac monitor (ICM) placement. Transthoracic echocardiogram (TTE) parameters collected included mitral e and e’ velocities, and LA volume index (LAVI). LA strain was calculated offline using speckle-tracking in apical 4 and 2 chamber views, during the reservoir, conduit, and contractile phases of the cardiac cycle. Strain measurements obtained in each view were averaged (Figure 1). AF episodes had to last at least 2 minutes to qualify as an AF event.

Results

The cohort consisted of 269 patients with cryptogenic stroke who underwent ICM placement between April 2015 to December 2020, of them 45 patients had AF detected by ICM during follow-up. Echocardiographic evidence of dilated LA measured using LAVI (p=0.043) as well as lower filling pressures measured using e/e’ (p=0.033) were significantly associated with AF. (Table 1). LA function using strain in reservoir, conduit, and contractile phases was not significantly associated with AF (Table 1).

Conclusion

Increased LA size, but not abnormal LA function was significantly associated with incident AF in patients with CS.
Sex-related differences on short-term prognosis in patients with acute myocardial infarction related cardiogenic shock receiving Impella support in Japan
Authors: Nakamura M , Imamura T , Ueno H , Kinugawa K
Published: November 2023

Background

Sex-specific outcomes in patients with acute myocardial infarction related cardiogenic shock (AMI-CS) receiving temporary MCS remains controversial in the United States. Survival benefit of Impella support in female patients in Japan also remains uncertain.

Purpose

This study examined sex-related differences in clinical outcomes among patients with AMI-CS receiving Impella support using the prospective multi-center J-PVAD registry data.

Methods

We included patients with AMI-CS who received Impella-incorporated temporary MCS and were enrolled in the J-PVAD registry between Jan 2021 and Dec 2022. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was 30-day survival.

Results

A total of 979 patients (average 71 y; female 21%; LVEF 30%) were included. All patients received revascularization and 69% of them received during Impella support. Female patients had a lower 30-day survival compared to male patients (60.2% vs 67.9%, p = 0.0089). Of note, female patients who received Impella support before revascularization had a greater survival compared to those who received Impella support after revascularization (69.2% vs 41.8%, Figure 1).

Conclusions

Female patients in AMI-CS had a lower short-term prognosis compared to male. Early initiation of Impella support before revascularization is highly recommended for those with AMI-CS.
Association between aortic valve opening during exercise and right ventricular reserve in patients with left ventricular assist device
Authors: Takenaka S , Sato T , Nagai T , Omote K , Kamiya K , Konishi T , Kobayashi Y , Tada A , Mizuguchi Y , Takahashi Y , Naito S , Saiin K , Ishizaka S , Wakasa S , Anzai T
Published: November 2023

Background

Aortic valve (AV) opening in patients after left ventricular (LV) assist device (LVAD) implantation is important to prevent adverse events. We hypothesised that right ventricular (RV) reserve function would play a crucial role to overcome pulmonary vascular resistance to ensure LV filling and AV opening in LVAD patients. However, detailed analysis between RV haemodynamic exercise response and AV opening with recent LVAD patients remains relatively unknown.

Purpose

The aim of this study was to explore the haemodynamic parameters observed during rest and maximal exercise and investigate the association of AV opening with RV reserve function and adverse events in patients with LVAD.

Methods

We prospectively examined 22 consecutive LVAD patients who were admitted to our university hospital between June 2020 and December 2022 after excluding those who were unable to perform exercise (n = 8). All patients underwent invasive exercise right heart catheterisation with simultaneous echocardiography in the supine position. AV status was assessed at rest and during exercise. RV stroke work index (RVSWI) was calculated as 0.0136 × stroke volume index × (mean pulmonary artery pressure – right atrial pressure) at rest and during exercise. RVSWI change from rest to peak exercise (ΔRVSWI) were calculated to evaluate RV reserve function. The patients were divided into three groups according to AV opening both rest and exercise (n = 6), AV opening only during exercise (n = 7), and AV closed both rest and exercise (n = 9).

Results

Patients were predominantly male (77%) and the median age was 51 (interquartile range [IQR] 39-63) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices or echocardiographic parameters and RVSWI at rest among the groups. Patients with AV opening both rest and exercise, and only during exercise had significantly higher ΔRVSWI than those with AV closed both rest and exercise (Figure A). During a median follow-up period of 433 (IQR 228-558) days, adverse events occurred in six patients (27%), including one death, one hospitalisation for major bleeding, and four hospitalisations for right heart failure. Kaplan–Meier analysis revealed that the adverse events more frequently occurred in patients with AV closed both rest and exercise compared to those with AV opening (p = 0.014) (Figure B).

Conclusions

In patients with LVAD, AV opening at rest or during exercise was associated with preserved RV reserve function and less adverse events. These findings suggest that the observation of the AV opening during exercise would be useful for early identification of high-risk patients with LVAD. Further studies are needed to confirm our findings.
Post-transplant left atrial function depends on the technique used for orthotopic heart transplantation
Authors: Obremska M , Przybylski R , Sokolski M , Rakowski M , Zakliczynski M , Ponikowski P , Kosmala W
Published: November 2023

Background

Even short episodes of post-transplant atrial fibrillation (AF) have been shown to increase the risk of adverse outcomes, including thromboembolic events, graft failure, and increased mortality. Of the two most commonly used heart transplantation techniques - bicaval and total orthotopic heart transplantation (OHTx), the former approach combines the donor and recipient atria, and may predispose to supraventricular arrhythmias, especially atrial fibrillation, as well as lead to a higher incidence of atrioventricular valve incompetence. Existing data relate mainly to the more non-physiological left atrial (LA) size and geometry after bicaval OHTx, while little is known about differences in LA function between patients treated with both techniques.

Aim

To compare LA functional and morphological characteristics between patients after bicaval and total OHTx.

Methods

The study group consisted of 28 patients who underwent OHTx between May 2021 and December 2022: 14 consecutive patients after total OHTx and 14 subjects after bicaval OHTx matched by age and time from heart transplant. Echocardiographic examination included standard measurements and left ventricle (LV) and LA longitudinal deformation assessment by speckle tracking technique.

Results

All enrollees were male. There were no differences between the groups after total and bicaval OHTx in anthropometric and laboratory parameters. Routine endomyocardial biopsies performed during follow-up after OHTx in all patients did not show severe graft rejection. No significant differences were found in LV dimensions, ejection fraction and stroke volume, Doppler velocities of mitral inflow and mitral annulus, as well as LV global longitudinal strain. In contrast to LV measures, significant between-group differences were demonstrated for LA parameters: LA volume index was significantly higher, and peak atrial longitudinal strain (PALS) corresponding to LA early diastole in the reservoir phase and peak atrial contraction strain (PACS) corresponding to LA systole were significantly higher in the total OHTx group than in the bicaval OHTx group (Table).

Conclusions

Total OHTx technique is associated with a more favorable LA morphology and function, which may explain the lower prevalence of atrial fibrillation reported in the literature in patients treated with this method. The clinical significance of reduced LA contribution to LV filling in patients subjected to bicaval OHTx needs further exploration.
Predictors on admission associated with successful weaning and in - hospital mortality in patients with refractory shock undergoing veno - arterial extracorporeal membrane oxygenation
Authors: Hong J Y , Hong J A , Kim S A , Kim H S
Published: November 2023

Introduction

In assessment of prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO), considerable data have been focused on predictors just before or after VA-ECMO initiation. The aim of this study is to determine the prognostic factors on admission in patients with refractory shock undergoing VA-ECMO.

Methods

A total of 307 patients (median age 57; interquartile rate [IQR]: 48-68, male 220 (72%)) who underwent VA-ECMO due to refractory shock from 2015 to 2021 were retrospectively analyzed. Successful weaning was defined as successful removal of VA-ECMO without mechanical support over the following 30 days. In-hospital mortality (IHM) was defined as death occurred during the hospital stay.

Results

Median duration of weaning and hospital stay was 10 days (IQR: 7-14) and 24 days (IQR: 9-43), respectively. Of all patients, 115 patients (37%) were successfully weaned from VA-ECMO and 191 (62%) died before discharge. Patients with successful weaning and survived before discharge had lower prevalence of sepsis, higher cystatin C based estimated glomerular filtration rate (cyc-eGFR) and total cholesterol, and lower blood urea nitrogen, C-reactive protein and INR on admission than those with failed weaning and those who had died. In multivariate regression analyses, sepsis, cyc-eGFR and INR on admission were independently associated with successful weaning and only cyc-eGFR on admission was remained as independent predictor of IHM. In an incremental model, the addition of cyc-eGFR significantly increased the χ² of the clinical and laboratory data model including creatinine based eGFR (Cr-eGFR), from 22.3 to 33.7 (p<0.001) for prediction of successful weaning and from 22.2 to 33.6 (p<0.001) for prediction of IHM, respectively.

Conclusion

Cyc-eGFR on admission showed an incremental prognostic value beyond Cr-eGFR on admission for prediction of successful weaning and IHM in patients with refractory shock undergoing VA-ECMO.
Urinary proteomics signature of malignancy post heart transplantation is associated with mortality risk
Authors: Wei D , Vanassche T , Verhamme P , Janssens S , Van Aelst L , Van Cleemput J , Zhang Z Y
Published: November 2023

Background

Heart transplant recipients are at an increased risk of malignancy that has an adverse impact on outcomes. The surveillance of malignancy after heart transplantation is cumbersome and involves multidisciplinary efforts.

Purpose

This study aimed to identify potential urinary proteomic biomarkers for the detection of malignancy and their predictive value for mortality risk after heart transplantation.

Methods

Urinary samples from 343 heart transplant recipients, including 27 with solid organ cancer, 23 with skin cancer, and 293 without cancer, were measured at baseline by capillary electrophoresis coupled with mass spectrometry. Multivariable logistic regression models and partial least squares-discriminant analysis were used to identify proteome differences between cancer and non-cancer patients. The association between proteomic signatures and mortality was assessed by Cox regression analysis.

Results

The urinary proteomics difference between solid organ cancer and non-cancer was 30 peptides involved in collagen degradation, cell adhesion and apoptosis, and tumorigenesis. The proteomic signature of skin cancer was comprised of 39 peptides related to collagen turnover, cell migration and invasion, and proliferation. These two proteomic signatures yielded an AUC of 0.93 (95% CI: 0.90-0.97) and 0.92 (0.88-0.97) for the detection of solid organ or skin cancer (P<0.0001), respectively. The corresponding AUCs provided by multiple clinical factors (sex, age, year after transplantation, immunosuppressive agents, blood pressure, HDL cholesterol, and eGFR) were 0.88 (0.82-0.93) and 0.82 (0.72-0.92). The proteomic signature of solid organ cancer (adjusted hazard ratio: 1.04 [1.01-1.07], P=0.007) and its constituted peptides (collagen type III and I, MLL cleavage product C180, and CD99 antigen-like protein 2) were significantly associated with mortality.

Conclusions

Urinary proteomic biomarkers might be used to screen malignancy after heart transplantation. Proteins involved in collagen metabolism, cell adhesion and proliferation, and tumorigenesis predicted cancer mortality after heart transplantation.Figure 1.WorkflowFigure 2.ROC curves
Predictors and outcomes of rejection requiring treatment within the first year following heart transplantation
Authors: Doulamis I , Tzani A T , Gemelli M G , Rempakos T R , Kampaktsis P K , Alvarez P A , Guariento A G , Briasoulis A B
Published: November 2023

Background

Heart transplant remains the mainstay of treatment for end stage heart failure not controllable with maximum pharmacotherapy or surgical interventions. One of the main considerations regarding heart transplant is the risk for graft rejection and the need for immunosuppression therapy to mitigate that risk.

Purpose

To assess the impact of the need for immunosuppression for rejection treatment within one year for heart transplantation on mortality. Secondary objectives include risk factors for the need for anti-rejection treatment.

Methods

The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for antirejection treatment within one year from heart transplantation.

Results

Patient demographics are summarized in Figure 1. Patients who required treatment for rejection within one year after transplant were younger (49±14 vs 52±14 years, p<0.001) and had higher CPRA value (14±26 vs 11±23, p<0.001) than patients who did not require treatment. Moreover, the majority of the patients who did not require antirejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplant after the new allocation policy implementation (65% vs 49%, p<0.001). The latter group had higher risk for 10-year mortality (HR: 1.34; 95% CI: 1.29, 1.39, p<0.001; Figure 2), although no difference was noted at the 1-year timepoint.

Conclusions

Although medical treatment of acute rejection was associated with similar 1-year mortality with patients who did not require antirejection therapy, 10-year mortality was higher in this patient population. Further studies and newer follow up data are required to investigate the role of antirejection therapy in the heart transplant population.Figure 1Figure 2
Non-HLA autoantibodies supplement donor specific antibodies in predicting graft survival after heart transplantation
Authors: Oh G , Lee H Y , Song E Y
Published: November 2023

Background

Presence of antibodies to donor-specific human leukocyte antigens (HLA) is a well-known risk factor associated with outcome in heart transplantation (HTx). However, non-HLA have also been associated with graft outcomes in HTx.

Purpose

We sought to assess the effect of non-HLA antibodies on graft outcome in Korean HTx patients.

Methods

Pre-transplant serum from patients undergoing HTx from January 2014 to December 2016 in four large transplant centers in Korea were analyzed. Presence of increased non-HLA antibodies, and their association with early (≤ 1-year) and long-term graft failure were assessed.

Results

Non-HLA antibodies were assessed in 192 patients. Antibodies to vimentin (AVA+) and type II collagen (ACA+) were associated with a lower rate of 1-year graft survival (78.6% vs. 92.6%-, log-rank p=0.006 for AVA+; 72.2% vs. 91.1%, log-rank p=0.015 for ACA+). Additionally, AVA+ stratified 1-year graft survival in patients with donor specific antibodies (DSA+) (45.5% vs. 94.1%, log-rank p=0.002). AVA+ also improved the prediction model for 1-year graft survival when added to known risk factors (IDI=11%, p=0.002; NRI=23%, p=0.047). ACA+ was also associated with lower rates in late graft survival (66.3% vs. 88.6%, log-rank p<0.001). Compared to AVA-/ACA- patients, AVA+/ACA+ patients had significantly poor graft survival both in the early and late periods (all log-rank p<0.001).

Conclusion

In our analysis of patients undergoing HTx, presence of non-HLA antibodies to vimentin and type II collagen were associated with poor graft outcomes. Pre-transplant assessment of non-HLA antibodies could help predict outcomes and tailor graft allocation and post-HTx immunotherapy in specific patients.Kaplan-Meier curves for graft survival
Reduced trans-myocardial extraction of endothelin-1 in cardiac allograft vasculopathy
Authors: Abraham G R , Davenport A P , Hoole S P
Published: November 2023

Introduction

Cardiac allograft vasculopathy (CAV) is a major cause of graft failure due to microvascular dysfunction and ischaemia following heart transplant. Endothelin-1 (ET-1) is an endothelium derived vasoconstrictor peptide with multiple adverse effects including vascular smooth muscle proliferation and pro-inflammatory signalling. Elevated circulating ET-1 has been associated with accelerated CAV.

We assessed the trans-myocardial gradient (TMG: coronary sinus minus coronary artery concentration: negative=extraction, positive=secretion) of ET-1 in heart transplant patients to determine correlations with angiographic, Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) features of CAV.

Methods

23 patients underwent invasive coronary angiography, 3-vessel grey scale IVUS (Opticross, 60mHz, Boston Scientific) and OCT (Dragonfly, Abbott Vascular) to define morphological features of vasculopathy 18±3 months post-transplant. Paired blood samples were obtained from the guide catheter and coronary sinus at the time of coronary imaging. Plasma was analysed using specific enzyme-linked immunosorbent assay for ET-1 peptide quantification. Survival was determined 98±5 months after initial assessment.

Results

ET-1 TMG distribution was mostly in the negative range reflecting net extraction across the coronary vascular bed (median [IQR]: -0.23 [-0.54, -0.02] pg/ml). However, vessels with more severe CAV demonstrated significantly more positive TMG i.e. less ET-1 trans-myocardial extraction (IVUS Stanford Grade IV: -0.05 [-0.21, 0.13] pg/ml versus Stanford Grade I-III: -0.31 [-0.64, -0.11] pg/ml, p = 0.01). ET-1 TMG was positively correlated with mean intimal thickness on both IVUS and OCT (IVUS: Kendall’s tau-b = 0.254, p=0.02 and OCT: Kendall’s tau-b = 0.344, p<0.0001). Patients who died had net ET-1 secretion compared with surviving patients (died: 0.21 [0.19 - 0.24] versus surviving: -0.28 [-0.52, -0.17], p = 0.01).

Conclusions

In heart transplant patients, coronary arteries with more intimal thickening had less trans-myocardial extraction, and more secretion of ET-1. ET-1 secretion in CAV may mediate the distal microvascular dysfunction commonly seen in this condition. These findings suggest a rationale for testing ET-1 receptor antagonists as a treatment for CAV.ET-1 TMG and IVUS Stanford Grade of CAVET-1 TMG and OCT derived MIT
Impact on mortality of heart transplantation preceded or not by continuous-flow left ventricular assist devices
Authors: Nafeh-Bizet C , Dumont M , Fauvel C , Aludaat C , Le Guillou V , Bouchart F , Olivier M E , Nardone N , Gay A , Omouri L , Bauer F
Published: November 2023

Background

Heart transplant (HT) is the therapy of choice in end-stage heart failure patients. With the scarcity of donors, bridge to transplantation (BTT) with left ventricular assist device (LVAD) becomes an option in patients awaiting HT. Criteria for HT listing do not differ between patients medically managed and those mechanically bridged to HT.

Objectives

The objectives of the present study is to assess the survival following HT preceding or not with LVAD as BTT and to evaluate differences in risk factors for 4-year mortality between those with (LVAD +) and those without LVAD (LVAD -) at the time of HT.

Methods

Using the local database, we identified 145 heart-transplanted adults (LVAD +, n=28 and LVAD -, n=117) between 2000 and 2020. Patients were propensity matched for likelihood of LVAD at the time of HT. Kaplan-Meier survival estimates were used to assess the impact of BTT on 30-day and 4-year mortality. Logistic regression analysis was used to evaluate the odds ratio of 4-year mortality for patients BTT with LVAD compared with those with medical management across clinically significant variables at various thresholds.

Results

30-day and 4-year post HT mortalities were similar in mechanically bridged patients or not: 10,7% versus 11,1% mortality (P=0,71), and 32,1% versus 35,9% mortality (P=0,61), respectively. Because outcomes were similar in both groups, risk factors for 4-year mortality were investigated in the total cohort of HT. Diabetes at the time of HT (CI [1.93–10.72], OR=4,55, p= 0.001), early post-HT hemorrhage (CI [2,01–15.23], OR=5,53, p= 0.001), and ventricular arrhythmia (CI [1.08–7,51], OR=2,84, p= 0.001) and late HT antidepressant drugs use (CI [0,02–0,51], OR=0,11, p= 0.005), incurred in the risk of 4-year mortality.

Conclusions

Bridge to HT with LVAD, although necessary because of organ scarcity and capable of improving wait list survival, confers no significantly risk of early and late posttransplantation mortality. Diabetes may require more careful consideration for transplant eligibility while antidepressant use are protective.Figure 1
Sleep apnea in patients with exacerbated heart failure and overweight
Authors: Kalaydzhiev P , Poroyliev N , Spasova N , Krastev B , Markov D , Kinova E , Goudev A
Published: November 2023

Background

Exacerbated heart failure is a condition with a high frequency of hospitalizations and mortality, especially in overweight patients. Screening and treatment for sleep apnea can be helpful in these patients.

Purpose

To determine the frequency and the phenotypic characteristics and of sleep apnea in patients with overweight and exacerbated heart failure. To assess systolic and diastolic function in patients with obstructive and central sleep apnea. To follow patients for one year and to assess hospitalization and mortality.

Methods

We conducted a single-centre, prospective cohort study form 120 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. 70 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) > 5, Epworth Sleepiness Scale (ESS) > 6, NTproBNP>900 pg/ml, and Body mass index(BMI) >25. All patients receiving optimal medical treatment. The follow-up period was 1 year. The primary endpoint was death for any reason. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio.

Results

From 70 with sleep apnea 73% (n=51) has obstructive sleep apnea (OSA) and 27% (n=19) has central sleep apnea (CSA). Detected significant changes in LVEF between the OSA group and CSA group (EF% 49.7±8.5vs43.3±9.6.4;p=0.008). Statistically significant changes there was about E/e’m ratio (E/e’m-17.01±3.7 vs 19.3±2.73; p=0.015) and BMI (BMI-38.2±6.5 vs 32.2±3.6; p<0.001). We found a moderate reverse correlation between the LVEF and the number of central sleep apnea events (r=-0,34;p=0,003). Simple linear regression was used to test if the left ventricular ejection fraction significantly predicted the number of central apnea events. The overall regression was statistically significant (R2 = 0.120, F(1,68) = 9.26, p = .003). It was found that the left ventricular ejection fraction significantly predicted the number of central apnea events (β = -0.06, p = .003). Patients from both groups were followed up regarding first hospitalization for heart failure and mortality over a period of 12 months. First hospitalization in patients with CSA occurs significantly sooner than in patients with OSA. The average number of months without hospitalization for HF in patients with CSA was 6.7 months versus 9.7 months in patients with OSA (Log Rank (Mental-Cox) p=0.012). The OSA group had a median survival of 10.5 months versus 9.3 months in the CSA group (Log Rank (Mental-Cox) p=0.026).

Conclusion

Sleep apnea is a common comorbidity in patients with exacerbated heart failure and overweight. OSA occurs to a greater extent than CSA. Patients with reduced systolic function are at higher risk of central sleep apneas events. Low LVEF% can be used as a prognostic factor regarding the occurrence of central sleep apnea events. Controlling sleep apnea can reduce patient readmissions and mortality.
Impact of age in the effectiveness of the implementation of a transitional-care heart failure program: a population-based analysis with real-world data in 77,554 patients
Authors: Torres B , Alcober L , Vela E , Cleries M , Corbella M , Jose N , Ramos R , Ras M , Jimenez S , Garay A , Alcoberro L , Pons A , Ruiz M , Enjuanes C , Comin-Colet J
Published: November 2023

Background

Old age has a negative impact in terms of outcomes and medical resource use in patients with heart failure (HF). The efficacy of HF management programs has been widely proved, however the influence of age in the effectiveness of HF programs is still unknown.

Purpose

To analyze the effect of age on health outcomes before and after a pragmatic implementation of an intensive transitional care nurse-based HF management program integrating hospital and primary care and resources for patients with HF at a high risk of events in a health-care area of 209,255 inhabitants.

Methods

For the purposes of this study, we included all individuals consecutively admitted to hospital with at least one ICD-9-CM code for HF as the primary diagnosis and discharged alive in Catalonia between January, the 1st, 2015 and December, the 31st of 2019. We considered 3 distinct periods of implementation of the HF program: pre-implementation (2015-2016), transition (2017) and consolidation (2018-2019). To evaluate the efficacy of the program according to age strata, we compared outcomes between HF patients of the implementation area and HF patients of the remaining healthcare areas of Catalonia across implementation periods and stratified according to age strata.

Results

We included 77,554 patients in the study: 3,396 in the implementation area (HUB-Delta area) and 74,158 in the rest of Catalonia. According to age, patients were classified as, 15-74 years age-group (19.624, 25.3%), 75-84 years age-group (28.054, 36.1%) and >84 years age-group (29.876, 38.5%). In the implementation area, all-cause death, clinically related hospitalizations and HF readmissions were significantly improved in the consolidation period compared to the pre-implementation period in all age-groups (Table 1). As shown in Figure 1, left column, the implementation of the program resulted in a significant improvement in all outcomes evaluated for the whole HF population of the HUB-Delta area compared to the rest of Catalonia. The improvement was consistent across all age groups (Figure 1, middle and right columns) in the consolidation period for all outcomes evaluated. However, in patients >84 years old, the size effect of improvement in patients of the HUB-Delta area tended to be attenuated when compared to the benchmark.

Conclusions

The risk of mortality, clinically related hospitalizations and HF hospitalizations in recently discharged patients with HF has an independent association with age. The implementation of an intensive transitional care nurse-based HF management program improves clinical outcomes across age strata. Remarkably these improvements are also seen in very old patients above 84 years old.Figure 1Table 1
A virtual heart failure ward in a rural demography
Authors: Roebuck A , Checkley J , Fawcett B
Published: November 2023

Background

Lincolnshire is a large rural county in the UK with wide economic variation, social deprivation, poor communication infrastructure and no large urban centre of population. As a result of these factors we have a significant incidence of heart failure and a variation in access to services. As part of a county wide initiative to improve the care of patients with heart failure and to reduce acute reduce admissions to hospital we introduced a virtual heart failure ward in January 2022. The ward is overseen by the community cardiology heart failure specialist nurses and led by a cardiology Advanced Clinical Practitioner (ACP) - a multi-professional worker educated to Level 7 with the ability to prescribe and request procedures/ investigations. Governance is from the acute cardiology team via multi-disciplinary meetings. Patients who are decompensating that historically would have required admission can be 'admitted' to the ward and patients who have been admitted to the acute hospital can also be admitted/ stepped down to facilitate discharge. The ward is supported by a 7/7 (expanded from 5/7 to support the project) specialist nursing team, weekly ward rounds, telemedicine (multi-provider app), remote monitoring (oximetry/ weight/ BP), outpatient IV furosemide, specialist heart failure rehabilitation (F2F and remote) and supports a seamless service between primary, community and secondary care.

Results

In the first 13-months N=213 patients were treated via the virtual ward. N=137 (64%) 'step up, N=75 (35%) step down, N=1 (self-referral), see figure one. N=194 patients were discharged. N=25 (12%) were admitted for escalation of care, see figure two. In the first year, we estimate that the virtual ward released 1,147 acute bed days (1,033 admission prevention and 114 early discharge) and delivered a cost reduction of approximately to £1m. An external audit team has identified a 10% reduction in heart failure admissions to the acute hospital. PROMS (patient recorded outcome measures) show high patient satisfaction and staff have found the enhanced 7/7 service beneficial and rewarding.

Discussion

Our experience of implementing a virtual heart failure ward in a rural demography has been exceedingly positive. We have observed significant reductions in admissions, facilitated early discharged from hospital with high patient and staff satisfaction. this intervention has also delivered a substantial cost saving to the wider health economy.Step Up/ Step DownDischarge Destinations
Association of cardiovascular health with incident heart failure in community population without cardiovascular disease: results of the China PEACE million persons project
Authors: Cai A P , Chen C L , Ou Y Q , Wang J B , Feng Y Q , Nie Z Q
Published: November 2023

Aim

To evaluate the association of cardiovascular health (CVH) with incident heart failure (HF).

Methods

The China PEACE million persons project is a nationwide, government-funded and population-based cardiovascular disease (CVD) screening study. This was a sub-cohort study of the project that included community-dwelling adults free of CVD. Components of CVH, including diet, physical activity, smoking status, sleep status, body mass index (BMI), non-HDL, blood glucose and blood pressure, were collected using self-report questionnaires. Each component and CVH were categorized as poor, intermediate and ideal status based on the AHA Life’s Essential 8 criteria. HF cases were identified by linking hospital records.

Results

Among the cohort (n=38571, median age 54 years and women 60.5%), proportion of individuals with poor, intermediate and ideal CVH was 30.7%, 56.9% and 12.4% respectively. After a median follow-up of 3.6 years, the incidence of HF in individuals with poor, intermediate and ideal CVH was 2.5%, 1.1% and 0.5% (P<0.001). Compared to poor CVH, intermediate (adjusted HR: 0.52 [95% CI: 0.43-0.61]) and ideal CVH (adjusted HR: 0.38 [95% CI: 0.26-0.57]) were associated with a lower risk of incident HF. A gradient of association between CVH and risk of incident HF was observed (P-trend < 0.001). Ideal physical activity, ideal smoking status, and intermediate and ideal status of BMI, blood glucose and blood pressure were independently associated with a lower risk of incident HF.

Conclusion

Poor CVH was independently associated with an increased risk of incident HF and promotion of CVH may have important implications for HF prevention.Graphical abstract
Biventricular dysfunction and lung congestion in post-COVID patients: a speckle tracking and stress lung echocardiography analysis
Authors: D'andrea A , Pandang S , Tagliamonte E , Boshchenko A , Colonna P , Wierzbowska-Drabik K , Zagatina A , Djordievic-Dikic A , Rigo F , Cocchia R , Ciampi Q
Published: November 2023

Background

Cardiovascular abnormalities have been observed in half of all COVID-19 patients in the acute phase of the infection. Additionally, 10-35% of these patients have various long-term symptoms diagnosed with post-acute sequelae of COVID-19 (PASC). Aim of this study was to evaluate the role of exercise stress echocardiography (ESE) with an integrated approach, inclusive of Speckle-Tracking Echocardiography (STE) with Myocardial Work (MW) analysis in the evaluation of patients after COVID infection.

Methods

We prospectively recruited a population of 370 post-COVID 19 patients (Group 1) (225 males; 55.8 ±8.3 years), and of 250 age- and sex-comparable healthy controls (Group 2). In Standard Doppler echocardiography, STE and MW analyses and lung ultrasound at rest and at peak supine-bicycle ESE were performed.

Results

Left ventricular (LV) wall thickness, diameters and mass index were comparable between the two groups. Both LV ejection fraction (EF) and right ventricular (RV) functional indexes (TAPSE and Tissue Doppler S’ wave) at rest did not show differences between the two groups. Conversely, baseline LV GLS (-16.2±2.8 vs. –20.4±3.3 %; p<0.01), MW efficiency (88.8±3.2 vs. 93.2±3.3 %; p<0.001), and RV strain (-16.4±2.8 vs. –20.4±4.3 %; p<0.01), were significantly reduced in Group 1. Also pulmonary artery systolic pressures (PASP) (33.5±3.8 vs. 24.6±3.1 mmHg; p<0.001), and LV E/e’ ratio were significantly increased in COVID group, while B-lines ( ≥ 2) at rest were found in 25.3% of Group 1 and 5.1% of Group 2 (p < 0.001). During effort, COVID patients showed reduced exercise time and exercise capacity (<0.001). Values of LVEF, RV strain and LV GLS (all with p value <0.01) and MWE (p<0001) were much lower in COVID patients when compared to Group 2. Additionally, COVID patients showed at peak effort an increased LV E/e’ ratio, pulmonary pressures and B-lines by lung ultrasound (all p <0.001). Multivariable analysis detected independent associations of baseline GLS and MWE with maximal workload (watts reached), LV E/e’ ratio and B-lines during effort (p<0.001), stronger than the association of LVEF with the same functional parameters (p<0.01). What’s more, RV strain (p<0.001) was significantly associated with PASP levels at peak effort.

Conclusions

In post-COVID patients, biventricular involvement with impairment of LV and RV systolic function is frequent, missed by conventional indices such as EF or TAPSE, and detected by more sensitive STE indices such as LV-GLS, ME, and RV-strain. These alterations are functionally significant and associated with shorter exercise -time, more pulmonary hypertension, and greater pulmonary congestion during stress.