bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of arterial stiffness on diastolic function and outcomes of heart failure in patients presenting with acute myocardial infarction
Authors: Kim K , Kang M.G , Koh J.S , Park J.R , Hwang S.J , Hwang J.Y , Park H.W
Published: November 2020

Background

Relation of arterial stiffness and cardiovascular disease is well-known. However, there is no data on association between diastolic function and brachial-ankle pulse wave velocity (baPWV) and influence on heart failure outcomes in patients with acute myocardial infarction (AMI).

Methods

Among patients presenting with AMI, all subjects underwent baPWV and echocardiography were recruited. Diastolic function was categorized by 2016 guideline of ASE/EACVI left ventricular diastolic function. Heart failure outcomes were defined 1) hospitalization for heart failure, 2) cardiac death and 3) sudden cardiac arrest.

Results

Totally 1,016 subjects were enrolled (FU duration; 3.5±2.0 years, mean age 65±13, predominant male 71.3% and STEMI 40.8%) from 2012 to 2015 in the our University Hospital. Elderly, female, low BMI, higher PWV, HTN, DM and stroke were associated with higher baPWV. Increased arterial stiffness (defined as baPWV ≥1700) had higher prevalence of diastolic dysfunction compared with baPWV <1700 (98.3% vs 86.2%). HF outcomes of 69 events were identified (HF; n=48, cardiac death; n=16, sudden cardiac arrest; n=2, death d/t HF; n=3). In the multivariate analysis, baPWV ≥1700, HTN and low BMI (23 kg/m2) were independent predictors for HF outcomes after adjustment with age, LVEF, DM and stroke (Table 1). Furthermore, KM curve showed that increased arterial stiffness was associated with higher prevalence of diastolic dysfunction and poor outcomes of heart failure (Figure 1).

Conclusions

In patients with AMI, arterial stiffness was associated with higher prevalence of diastolic dysfunction an independent predictor for heart failure hospitalization and cardiac death.

Figure 1. Diastolic dysfunction and HF in AMI

Funding Acknowledgement

Type of funding source: None
Genome wide association analysis in dilated cardiomyopathy revealed two new susceptibility loci for systolic heart failure
Authors: Garnier S , Harakalova M , Weiss S , Mokry M , Van Setten J , Proust C , Duboscq-Bidot L , Boland A , Deleuze J.-F , Dorr M , Asselbergs F.-W , Cambien F , Villard E , Tregouet D.-A , Charron P
Published: November 2020

We conducted the largest Genome Wide Association Study performed so far in Dilated Cardiomyopathy (DCM), a leading cause of systolic heart failure and cardiovascular death. Using a discovery phase of 2,719 cases and 4,440 controls and a replication phase of 584 independent cases and 966 controls, we identified and replicated two new DCM-associated loci, one on chromosome 3p (meta-analysis OR = 1.36 [1.25 - 1.48], p=5.3 10–13) and the second on chromosome 22q (meta-analysis OR = 1.33 [1.22 - 1.46], p=5.0 10–10), while confirming the two previously identified DCM loci on chromosome 10 and 1, BAG3 and HSPB7. We estimated the global heritability to 31% ± 8%. The genetic risk score constructed from the number of lead risk-alleles at these 4 loci revealed a 27% risk increased in individuals with 8 risk-alleles compared to the 5 risk alleles reference group (OR = 1.27 [1.14–1.42]).

The two association signals were then fine-mapped by combining in silico and functional genomics investigations (as 4C-sequencing on iPSC-derived cardiomyocytes). While a few genes remain candidates at the second locus and deserve further investigations, our work clearly identified one gene as responsible for the association at the first locus whose role in the pathophysiology of DCM is supported by recent observations in human and mice. As the biological pathway in which this gene is involved is a potential target for pharmacological agents, our finding opens novel therapeutic perspectives for treating or preventing heart failure.

We are convinced that these results provide new findings that add both on the understanding of the genetic architecture of heart failure and on potential new players involved in the pathophysiology of this devastating disease.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): GENMED Laboratory of Excellence on Medical Genomics, DETECTIN-HF project (ERA-CVD framework), Assistance Publique-Hôpitaux de Paris, Délégation à la recherche clinique, the “Fondation LEDUCQ”, the PROMEX charitable foundation, the Société Française de Cardiologie/Fédération Française de Cardiologie, the Deutsche Forschungsgemeinschaft, The Federal Ministry of Education and Research and the Ministry of Cultural Affairs and the Social Ministry of the Federal State of Mecklenburg-West Pomerania, The German Center for Cardiovascular Research (DZHK), Hospitals NIHR Biomedical Research Centre, NWO VENI grant (no. 016.176.136)
Prognostic implications of myocardial work in patients with reduced left ventricular ejection fraction: a preliminary study
Authors: Strada S , Casas Masnou G , Gonzalez Fernandez V , Lozano Torres J , La Mura L , Cinque A , Pisaniello M , Valente F , Fernandez Galera R , Gutierrez Garcia Moreno L , Galian Gay L , Teixido Tura G , Gonzalez Alujas M.T , Ferreira Gonzalez I , Rodriguez Palomares J.F
Published: November 2020

Background

Myocardial work (MW) is a new imaging technique to assess left ventricular (LV) systolic function. It incorporates both deformation parameters (global longitudinal strain -GLS-) and loading conditions and gives information on global constructive work (GCW), global wasted work (GWW), global LV myocardial work index (GWI) and global LV myocardial work efficiency (GWE).

Purpose

The aim of this study was to describe the prognostic role of MW in predicting major adverse cardiovascular events (MACE) in patients with reduced LV ejection fraction (LVEF), and to compare it with GLS and LVEF.

Methods

We retrospectively included consecutive patients from 2012 to 2019 with dilated LV and LVEF <50% of any aetiology. Clinical variables were collected and LVEF, GLS and MW were evaluated from baseline echocardiogram. MACE was defined as heart failure (HF) and/or ventricular arrhythmia (VA) and/or cardiac arrest and/or all cause death.

Results

99 patients were included, 26 were women (26.3%), mean age at diagnosis was 57 years (SD 23). Mean LVEF was 32.5% (SD 10.3). Baseline patients characteristics are described in Table 1. During a median follow-up of 25 months (IQR 12), 24 MACE were recorded (24.4%). Patients with MACE had worse MW parameters: significantly lower MWI (805±360% vs 638±277%, p=0.04) and lower GCW (1116±535 mmHg vs 874±458 mmHg, p=0.05), and a tendency to lower GWE (83±11% vs 77±16%, p=0.084). Of note, both LVEF (33±10% vs 29±9%, p=0.123) and GLS (−9.99±3.7% vs −8.8±3.0, p=0.170) showed a trend but were not significantly associated with outcomes. This might suggest that MW variables are stronger prognostic predictors than traditional imaging parameters.

Conclusions

In patients with reduced LVEF, MW parameters including global MWI and GCW were associated with major adverse cardiovascular events. Of note, both EF and GLS seem to have less prognostic implications in this cohort when compared with MW. Our results are preliminary and larger studies are needed in order to fully understand the clinical utility of MW beyond traditional parameters.

Results

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Universitary Hospital Vall d'Hebron
Temporal trends in cause-specific readmissions and their risk factors in heart failure patients in Sweden
Authors: Cui X , Zhou J , Pivodic A , Dahlstrom U , Ge J , Fu M
Published: November 2020

Background

It remains unclear whether readmissions of patients with heart failure (HF) have decreased over time in an era of improved therapy and management of HF. This study aimed to determine the temporal short- and long-term trends of cause-specific rehospitalization and their risk factors in a Swedish context.

Methods

HF patients in the Swedish Heart Failure Registry (SwedeHF) were investigated. Maximum follow-up time was 1 year. Outcomes included the first occurrence of all-cause, cardiovascular (CV) and HF rehospitalizations. Cox proportional hazards models were performed to determine the impact of increasing years on risk for rehospitalization and its known risk factors.

Results

Totally, 25,644 index-hospitalized HF patients SwedeHF from 2004 to 2011 were enrolled in the study. For 8 years, the incidence risk of 1-year all-cause rehospitalization remained unchanged, whereas the incidence risk of CV (P=0.038) or HF (P=0.0038) rehospitalization decreased. After adjustment for age and sex, a 3% decrease per every second year was observed for 1-year CV and HF rehospitalizations (P<0.05). However, time to the first occurring all-cause, CV and HF rehospitalization did not change significantly from 2004–2011 (P-values 0.13–0.87). When two study periods (2004–2005 vs. 2010–2011) were compared, the risk factor profile for rehospitalization was found to change.

Conclusions

Throughout the 8-year study period, CV- and HF-related rehospitalizations decreased, whereas all-cause rehospitalization remained unchanged, indicating a parallel increase in non-CV rehospitalization in the HF patients.

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish Society of Cardiology and the Swedish Heart-Lung Foundation.
Chronic heart failure in younger patients: temporal trends in clinical characteristics, treatment and outcomes over two decades in a nationwide cardiology registry
Authors: Iacoviello M , Marini M , Gori M , Gonzini L , Benvenuto M , Cassaniti L , Municino' A , Navazio A , Ammirati E , Catalano M , Floresta M , Scopelliti G , Nassiacos D , Gorini M , De Maria R
Published: November 2020

Aim of the study

We analyzed the temporal trends in characteristics, therapy and outcomes over two decades of younger chronic heart failure (CHF) patients enrolled in our nationwide registry.

Methods

Among the 14823 CHF patients enrolled in the registry since January 1999 through May 2018, 5465 (37%) were aged<65 years (78% men, 54+9 years, left ventricular ejection fraction (LVEF) 36+11%). Patients were divided into 3 cohorts according with the recruitment epoch: 1999–2005; 2006–2011; 2012–2018. We analyzed trends over time of clinical characteristics, therapy, one-year all-cause mortality, all-cause mortality and/or all-cause hospitalization, all-cause mortality and/or CV hospitalization, and all-cause mortality and/or HF hospitalization.

Results

From 1999 to 2018 the proportion of patients <65 years declined: 42% in first (2288/5404), 37% in second (1464/3971), 31% in third period (1713/5448).

As shown in the Table, the proportion of women, diabetes, ischemic etiology and renin-angiotensin system inhibitor prescription did not change significantly among the three enrollment epochs, whereas preserved LVEF phenotype and prevalence of its driving risk factors increased. The proportion of guideline-recommended drug & device therapies significantly rose over time. All-cause mortality at 1-year follow-up decreased significantly across the 3 epochs studied (Figure).

Conclusions

During 20 years, the clinical characteristics, the implementation of recommended treatments and prognosis of patients <65 years enrolled in a nationwide cardiology registry have deeply changed. These modifications reflect the evolution of cardiovascular risk factors and improved management strategies of CV disease.

Figure 1

Funding Acknowledgement

Type of funding source: Foundation. Main funding source(s): Fondazione per il Tuo cuore – HCF onlus
Temporal trends, sex-differences and outcomes of patients hospitalized for heart failure in Germany
Authors: Goebel S , Hobohm L , Gori T , Ostad M.A , Muenzel T , Wenzel P , Keller K
Published: November 2020

Background

Despite remarkable improvements in treatment of cardiovascular disease, heart failure (HF) is still characterized by a high mortality rate. Sex-specific differences in HF have been described, but underlying reasons are widely unexplored. Thus, we aimed to investigate sex differences of patients hospitalized for HF in a nationwide cohort.

Methods

The nationwide German inpatient sample (2005–2016) was used for this sex-specific analyses. Temporal trends on hospitalizations, mortality, and treatments were analyzed and independent predictors of adverse outcomes identified.

Results

The present analysis comprises 4,538,977 hospitalizations due to HF (52.0%women) in Germany (2005–2016). Although women were older (median 82 (IQR75–87) vs. 76 (69–82), P<0.001), coronary artery disease (CAD, 50.3% vs. 30.7%, P<0.001) was more prevalent in men, who were more often treated with PCI (3.4% vs. 1.4%, P<0.001) and implantable cardioverter-defibrillator (2.2% vs. 0.5%, P<0.001). In-hospital mortality was significantly lower in men than in women (8.9% vs. 10.2, P=0.001) and was reduced in patients who received PCI or implantation of an ICD.

While total numbers of hospitalizations between 2005 and 2016 increased in both men (β-estimate 7185.71 (95% CI 6502.23 to 7869.18), P<0.001) and women (β-estimate 5297.60 (95% CI 4557.37 to 6037.83), P<0.001) as well as almost all comorbid co-conditions, in-hospital mortality rate decreased more distinctly in women (β-estimate −0.41 (95% CI: −0.42 to −0.39), P<0.001) compared to men (β-estimate −0.29 (95% CI: −0.30 to −0.27), P<0.001).

Conclusions

Interventional treatments of HF were associated with improved outcomes and equally beneficial for both sexes. However, they were more often used in male HF patients, in which CAD is significantly more frequent than in female HF patients. This may explain the higher case fatality rate of HF in females.

Funding Acknowledgement

Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research (BMBF)
Caregiver burden of patients with heart failure with a left-ventricular ejection fraction (LVEF) less than or equal to 60%: a cross-sectional survey in the EU
Authors: Lahoz R , Corda S , Proudfoot C , Fonseca A.F , Cotton S , Jackson J , Studer R
Published: November 2020

Background and purpose

The majority of patients with heart failure (HF) have difficulties in independently carrying out activities of daily living and hence, require support from caregivers (CGs). This study assessed the quality of life (QoL) of CGs of HF patients with sub-normal LVEF (≤60%).

Methods

A cross-sectional survey of HF patients and their CGs was conducted in France, Germany, Italy, Spain and the UK. Cardiologists and primary care physicians completed patient record forms (PRF) between June and November 2019. Caregivers of the same patients were invited to complete a caregiver self-completion survey, which included the Family Caregiver QoL Scale (FAMQOL) and EQ-5D. Patient demographics were derived from PRFs.

Results

361 CGs (73.1% female, mean age: 58.8 yrs) and HF patients (39.9% female, mean age: 71.2 yrs) were included. 58.2% of the CGs were spouses, 23.4% a child of the patient. On average, CGs devoted 20 hrs/week in the care of HF patients; this CG time increased from 12 to 26 hrs/week with NYHA class I to III/IV of the HF patient. Further, anxiety/stress was experienced overall by 29/31% of CGs which increased from 27/17% for NYHA I to 40/41% for NYHA III/IV of the HF patient (Table 1).

Conclusions

Caregivers of patients with HF and LVEF ≤60% spend a significant amount of time to provide daily support to HF patients. Patients with progressive disease were older, more polymorbid and had a higher disease duration. These factors likely contributed towards increased caregiver burden of HF patients with increased NYHA class.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Differences in clinical and prognosis patient's characteristics between acute heart failure with mid-range ejection fraction compared to heart failure with other ejection fraction groups
Authors: Gorriz Magana J , Espinosa Pascual M.J , Olsen Rodriguez R , Abad Romero R , Perela Alvarez C , Nieto Ibanez D , Fraile Sanz A , Saavedra Falero J , Perea Egido J
Published: November 2020

Background

There are scarce data on clinical profile and prognosis of pts with Heart failure with mid-range ejection fraction (HFmrEF). The aim of this study was to analyse the patient's characteristics and their prognosis in terms of morbidity and mortality compared to those patients with acute heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction

Methods

We performed a retrospective analysis from a prospective observational study developed in a University Hospital, which covers 220.000 individuals. We analysed 600 discharges with the main diagnosis of Heart Failure with 52 months of median follow up. We obtain clinical and demographic data at the moment of admission and during de follow up. To analyse mortality and readmission we used a Kaplan-Meier model.

Results

A total of 551 patients (91%) had a transthoracic echocardiogram (TEE) during the admission. Eleven percent (11.8%) of the patients (pts) had HFmrEF (35.6% of them were women), 66.7% HFpEF (81.8% women) and 20.6% HFrEF (29.0% women).

Median age of HFmrEF was 80.5±1.3 years, similar to HFpEF (81±0.5 years). However, pts with HFrEF were younger (75.2±1.1 years). A higher percent of pts with HFrEF were on beta-blocker (BB) treatment at admission compared to HFmrEF (51.79% vs 47.54%) and HFpEF (39.91%). At discharge, all of them were on high doses of BB (64.55% HFrEF, 54.10% HFmrEF and 33.62% HFpEF).

After an adjusted analysis by age, pts with HFmrEF had higher mortality compared to HEpEF (HR: 0.55; 95% CI: 0.38–0.80; p=0.002) with no statically significant difference compared to HFrEF (HR: 0.88; 95% IC: 0.57–1.35; p=0.5). Pts with HFmrEF were on a higher risk of readmission compared to HFpEF (HR 0.59; 95% CI 0.41–0.84, p=0.004). There was also no statistical difference compared to HFrEF (HR 0.72, 95% CI 0.47–1.11; p=0.14).

Conclusions

According to our results, pts with HFmrEF and HFpEF are older compared to HFrEF. HFpEF were mostly women, compared to other groups. A lower percent of HFmrEF were also on BB treatment. HFmrEF and HFrEF had a similar prognosis in terms of readmission and mortality. HFmrEF pts were on higher risk of mortality and readmission compared to HFpEF. We need more studies to find more information and confirm these results.

Graph 1

Funding Acknowledgement

Type of funding source: None
Coronary sinus catalase and ceruloplasmin levels predict all-cause mortality in patients with end-stage heart failure awaiting heart transplantation
Authors: Szczurek W , Gasior M , Skrzypek M , Kubiak G , Kuczaj A , Szygula Jurkiewicz B
Published: November 2020

Background, As a consequence of the worldwide increase in life expectancy and due to significant progress in the pharmacological and interventional treatment of heart failure (HF), the proportion of patients that reach an advanced phase of disease is steadily growing. Hence, more and more numerous group of patients is qualified to the heart transplantation (HT), whereas the number of potential heart donors has remained invariable since years. It contributes to deepening in disproportion between the demand for organs which can possibly be transplanted and number of patients awaiting on the HT list. Therefore, accurate identification of patients who are most likely to benefit from HT is imperative due to an organ shortage and perioperative complications.

Purpose

The aim of this study was to identify the factors associated with reduced survival during a 1.5-year follow-up in patients with end-stage HF awating HT.

Method

We propectively analysed 85 adult patients with end-stage HF, who were accepted for HT at our institution between 2015 and 2016. During right heart catheterization, 10 ml of coronary sinus blood was additionally collected to determine the panel of oxidative stress markers. Oxidative-antioxidant balance markers included glutathione reductase (GR), glutathione peroxidase (GPx), glutathione transferase (GST), superoxide dismutase (SOD) and its mitochondrial isoenzyme (MnSOD) and cytoplasmic (Cu/ZnSOD), catalase (CAT), malondialdehyde (MDA), hydroperoxides lipid (LPH), lipofuscin (LPS), sulfhydryl groups (SH-), ceruloplasmin (CR). The study protocol was approved by the ethics committee of the Medical University of Silesia in Katowice. The endpoint of the study was mortality from any cause during a 1.5 years follow-up.

Results

The median age of the patients was 53.0 (43.0–56.0) years and 90.6% of them were male. All included patients were treated optimally in accordance with the guidelines of the European Society of Cardiology. Mortality rate during the follow-up period was 40%. Multivariate logistic regression analysis showed that ceruloplasmin (odds ratio [OR] = 0.745 [0.565–0.981], p=0.0363), catalase (OR = 0.950 [0.915–0.98], p=0.0076), as well as high creatinine levels (OR = 1.071 [1.002–1.144], p=0.0422) were risk factors for death during 1.5 year follow-up.

Conclusions

Coronary sinus lower ceruloplasmin and catalase levels, as well as higher creatinine level are independently associated with death during 1.5 year follow-up.

Funding Acknowledgement

Type of funding source: Public Institution(s). Main funding source(s): Medical University of SIlesia, Katowice, POland
Positive effect of dapagliflozin on left ventricular longitudinal function for type 2 diabetic mellitus patients with chronic heart failure
Authors: Tanaka H , Soga F , Tatsumi K , Mochizuki Y , Sano H , Toki H , Matsumoto K , Shite J , Takaoka H , Doi T , Hirata K
Published: November 2020

Background

Type 2 diabetes mellitus (T2DM) has come to be considered an independent predictor of mortality, and also a contributor to the development of heart failure (HF) with reduced ejection fraction (HFrEF) and with preserved ejection fraction (HFpEF). Left ventricular (LV) longitudinal myocardial dysfunction as assessed in terms of lower global longitudinal strain (GLS), has been identified even in T2DM patients with preserved LV ejection fraction (LVEF), and should be considered the first marker of a preclinical form of DM-related cardiac dysfunction, leading to HFpEF. Sodium glucose cotransporter type 2 (SGLT2) inhibitors represent a new class of anti-hyperglycemic agents for T2DM, but the effect of SGLT2 inhibitors on LV longitudinal myocardial function in T2DM patients with HF remains uncertain. To examine this effect, as well as the association of LV longitudinal myocardial function with LV diastolic function after administration of SGLT2 inhibitor in T2DM patients with stable HF, we analyzed data from our previous prospective multicenter study, in which we investigated the effect of SGLT2 inhibitor on LV diastolic functional parameters of T2DM patients with stable HF at five institutions in Japan.

Methods

Our previous trial was a prospective multicenter study of 58 T2DM patients with stable HF at five institutions in Japan. Patients who had been taking at least one antidiabetic drugs other than SGLT2 inhibitors started the administration of 5 mg/day of dapagliflozin. Echocardiography was performed at baseline and 6 months after administration of dapagliflozin. LV diastolic function was defined as the ratio of mitral inflow E to mitral e' annular velocities (E/e'). LV longitudinal myocardial function was assessed as GLS based on the current guidelines.

Results

E/e' significantly decreased from 9.3 to 8.5 cm/s 6 months after administration of dapagliflozin (p=0.020) as previously described, while GLS showed significant improvement from 15.5±3.5% to 16.9±4.1% (p<0.01) 6 months after administration of dapagliflozin. Furthermore, improvement of GLS in HFpEF patients was more significant from 17.0±1.9% to 18.7±2.0% (p<0.001), compared to that in HFrEF patients from 11.3±3.8% to 11.8±4.6% (p=0.13). It was noteworthy that multiple regression analysis showed that the change in GLS after administration of dapagliflozin was the only independent determinant parameter for the change in E/e' after administration of dapagliflozin.

Conclusion

Dapagliflozin was found to be associated with improvement of LV longitudinal myocardial function, which led to further improvement of LV diastolic function of T2DM patients with stable HF. GLS-guided management may thus lead to improved management of T2DM patients with stable HF.

Representative case

Funding Acknowledgement

Type of funding source: None
A decrease in tricuspid regurgitation pressure gradient during follow-up in patients with heart failure
Authors: Seko Y , Kato T , Yamamoto E , Yaku H , Morimoto T , Inuzuka Y , Tamaki Y , Ozasa N , Yoshikawa Y , Nagao K , Kawase Y , Kuwahara K , Kimura T
Published: November 2020

Objective

This study aimed to investigate the prognostic impact of the decrease in tricuspid regurgitation pressure gradient (TRPG) at 6-month follow-up in patients after discharge with heart failure (HF).

Background

No previous study has reported the association between TRPG decrease during follow-up and clinical outcomes in HF.

Methods

Among 748 patients with 6-months follow-up echocardiography after discharge from the acute decompensated heart failure in 19 centers in Japan, we analyzed 721 patients with available TRPG data and divided into two groups: the decrease in TRPG group (N=179) and no decrease in TRPG group (N=542). We defined the decrease in TRPG as >10mmHg decrease compared in the initial hospitalization. The primary outcome measure was a composite of all cause deaths and hospitalization due to HF.

Results

The patients in the decrease in TRPG group had a lower prevalence of hypertension, dyslipidemia, atrial fibrillation, and a reduced EF, higher levels of blood albumin and lower levels of sodium than those in no decrease in TRPG group. The median follow-up duration after the follow up echocardiography was 302 (inter quartile range: 206–490), with a 90.9% follow up rate at 6-month. The cumulative 6-month incidence of the primary outcome measure was significantly lower in the decrease in TRPG group than in no decrease in TRPG group (12.2% vs. 18.9%, P=0.0011). After adjusting confounders, the excess risk of the decrease in TRPG relative to no decrease in TRPG for the primary outcome measure remained significant (HR: 0.60, 95% CI 0.34–0.99). There were no significant interactions between the subgroup factors and the effect of the decrease in TRPG for primary outcomes.

Conclusions

HF patients with the decrease in TRPG at 6-month after discharge had a lower risk of clinical outcome than those without decrease in TRPG.

Funding Acknowledgement

Type of funding source: None
Sacubitril/valsartan in real-life European patients with heart failure with reduced ejection fraction: a systematic review and meta-analysis
Authors: Giovinazzo S , Carmisciano L , Toma M , Sormani M.P , Canepa M , Senni M , Porto I , Ameri P
Published: November 2020

Background

Real-world data are needed to gauge how a therapy is implemented in clinical practice.

Methods

We systematically reviewed the abstracts presented at international congresses and the peer-reviewed original research articles, which described the use of sacubitril/valsartan in European patients with HFrEF from Sep 2014 until Nov 30, 2019. Meta-analysis estimates were combined using a random effects model with inverse variance weights.

Results

15 abstracts and 11 articles, including 14,179 patients, were selected. Except for a study that evaluated 12,082 (85,2%) subjects, the sample size was 28 (0.2%) to 1,120 (7.9%) patients.

Taking as reference PARADIGM-HF, few baseline characteristic were reported for >80% of the pooled population (Table), while all other ones were available for 12% of subjects or less (Figure). Underreporting was less common for articles than for abstracts (OR 0.42, 95% CI: 0.20–0.91).

Compared with the patients enrolled in PARADIGM-HF, those in real-life were older and more likely to being previously treated with ARB, MRA and diuretics (Table). NYHA class III-IV (OR 2.39, 95% CI: 1.58–3.59; I2=92%), ICD (OR 4.21, 95% CI: 2.31–7.69; I2=93%) and CRT (OR 4.53, 95% CI: 3.89–5.27; I2=0%) were also more likely, while a history of hypertension was less frequent (OR 0.61, 95% CI: 0.42–0.87; I2=82%).

The monthly achievement rate of the full dose of sacubitril/valsartan was 6%. When follow-up was ≥6 months, the percentage of subjects reaching the full dose was about 40% and very homogenous. Age and full dose attainment were inversely related (β −2.71, 95% CI: −5.3 to −0.1).

All cause-mortality and hospitalization rates were 6/100 person-year (9 studies, 1046 patients) and 25/100 person-year (5 studies, 775 patients), respectively.

Conclusions

With the limitation of being heterogeneous and of overall low quality, the literature suggests that, in Europe, sacubitril/valsartan is prescribed to patients with somehow more severe HFrEF than in the pivotal trial, who most often do not reach the full dose.

Funding Acknowledgement

Type of funding source: None
Guideline-based and personalized treatment approach to reduce hospitalizations and mortality for high risk advanced chronic systolic heart failure
Authors: Sisakian H , Hovhanisyan M , Lopatin Y.U , Martirosyan G.E , Minasyan A.M , Pepoyan S , Melik-Stepanyan S , Magakelyan A.A , Chopikyan A , Shahnazaryan S , Sahakyan L
Published: November 2020

The aim of our research was to evaluate mortality and rehospitalizations rates in patients with high risk subtype of heart failure (advanced HF) during 12 months of intensive monitoring after discharge on the basis of guidelines recommendations and personalized approach in treatment with frequent outpatient monitoring to reveal subcompensation/worsening of HF.

Methods

High risk advanced subtype of systolic HF was determined based on at least two hospitalizations during last year, severely reduced EF<30%, right and left atria hypertension echo patterns, pseudonormal/restrictive diastolic dysfunction, frequent outpatient deterioration of euvolemic state.

Patients were randomized into two groups: 143 patients who underwent personalized intensive outpatient monitoring with care and 71 patients who underwent standard monitoring with regular guideline based treatment

Intensive monitoring in ambulatory settings included frequent attending protocol of clinical evaluation (from OPTIMIZE -HF multicenter study), body mass, heart rate, GFR controls and additional echo evaluation of pressures in right and left atria at every outpatient visit, lung ultrasound with detection of B-lines.

Results

Cumulative number of CV and HF deaths was 11% (16 out of 143 in intensive monitoring group) and 36% (26 out of 71 patients) in standard monitoring group.

Kaplan-Meier curve showed survival benefit in patients with personalized monitoring and treatment compared to those who were on standard care (Picture 1).

Conclusions

A strong trend towards decline in mortality and rehospitalizations, when personalized outpatient monitoring was implemented was observed (P<0,001) at 12 months in patients with advanced systolic heart failure.

Kaplan-Meier survival curves groups

Funding Acknowledgement

Type of funding source: None
Improving atrioventricular coupling in heart failure patients with PR prolongation, the ReachPR Trial
Authors: Salden F , Luermans J.G , Van Stipdonk A.M.W , Allaart C.P , Meine M , Prinzen F.W , Vernooy K
Published: November 2020

Background

PR prolongation is associated with poor hemodynamic performance and may contribute to heart failure (HF). There is some evidence that in HF patients, normalization of atrioventricular (AV) coupling can attenuate HF.

Purpose

To investigate acute hemodynamic effects of restoration of AV coupling by atrio-biventricular (BiV) pacing in patients with HF and PR prolongation, but without evident ventricular dyssynchrony.

Methods

Nineteen patients underwent BiV pacemaker implantation. An invasive hemodynamic pacing protocol was performed during BiV and right ventricular (RV) pacing with four paced AV delays (100, 75, 50 and 25% of patient's PR interval during baseline AAI pacing). All patients had symptomatic HF, left ventricular ejection fraction (LVEF) <35% and PR interval ≥230 ms, without evident prolonged QRS duration >150 ms or left bundle branch block. Acute hemodynamic response was assessed by invasive left ventricular (LV) stroke work measurements (conductance catheter technique).

Results

At baseline, PR interval was 255±22 ms, QRS duration 122±19 ms and LVEF 29±6%. Reducing AV delay to 50% of patient's intrinsic PR interval by BiV pacing resulted in a median 25% increase (p<0.05) in LV stroke work relative to baseline (figure, left panel). This increase in LV stroke work was mainly determined by an increase in LV stroke volume (figure, right panel). In contrast to BiV pacing, reducing AV delay by RV pacing did not improve LV stroke work (figure, left panel).

Conclusion

In patients with HF and PR prolongation, BiV pacing can be used to improve AV coupling that leads to hemodynamic improvement. These results suggest that BiV pacing may also be beneficial in this subset of HF patients that are currently not indicated for CRT.

ReachPR Trial

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Abbott funded a part of this study.
Glucagon-like peptide-1 receptor agonists (GLP-1 RA) as adjunct to standard treatment in diabetic patients with chronic heart failure: a systematic review & meta-analysis
Authors: Afaga D.N , Esguerra J.C.A , Europa M.L.R , Cabaluna I.T.G
Published: November 2020

Background

Glucagon-like peptide 1 receptor agonists' (GLP-1 RA) effect on secondary prevention of MACE has yet to be investigated in diabetic patients with chronic heart failure.

Purpose

We aimed to determine the effectiveness of GLP-1 RA as adjunct to standard treatment among diabetic patients with chronic heart failure (LVEF <50%), in preventing major adverse cardiovascular events (MACE): cardiovascular death, nonfatal myocardial infarction, and nonfatal stroke.

Methods

We searched for eligible trials reporting MACE, all-cause mortality, hospitalization for heart failure, improvement of LVEF and functional capacity (6-minute walk test). Fixed-effects model was used to estimate overall risk ratio for MACE, all-cause mortality and hospitalization for heart failure, while mean difference was used for estimation of improvement of LVEF and functional capacity. Review Manager 5.3 was used for analysis.

Results

Ten studies (56,597 patients) were included: LIVE, FIGHT, ZHANG, LEADER, ELIXA, SUSTAIN-6, PIONEER-6, EXSCEL, HARMONY, and REWIND. Addition of GLP-1 RA and Liraglutide did not significantly reduce MACE (RR 0.90, CI 95% [0.78–1.03]), (RR 0.91, CI 95% [0.69–1.20]). Moreover, Liraglutide did not significantly reduce cardiovascular death (RR 0.99, CI 95% [0.14–7.15]). No significant effect on LVEF and functional capacity was demonstrated in this study.

Conclusion

GLP-1 RA use in diabetic patients with chronic heart failure may have modest effect on functional capacity but did not significantly affect MACE, all-cause mortality, and LVEF.

Funding Acknowledgement

Type of funding source: Private hospital(s). Main funding source(s): Department of Internal Medicine, Manila Doctors Hospital
Sex differences in pharmacological therapy among heart failure patients: a systematic review and meta-analysis
Authors: Danielson C , Lileikyte G , Teng T.H.K , Ouwerkerk W , Lam C.S.P , Erlinge D
Published: November 2020

Background

Renin Angiotensin System Inhibitors (RASi) and Beta-Blockers (BB) have been proven effective in trials of heart failure with reduced ejection fraction (HFrEF) in which men were overrepresented. Recent studies have suggested sex differences in pharmacological therapy benefits in HF. We aimed to perform a systematic review and meta-analysis comparing treatment effect among women and men with HFrEF.

Method

Systematic search was performed on PubMed, Cochrane Library and Embase for RCTs published 1990–2019. Treatments included BB and RASi. Selected outcomes were all-cause mortality and combined outcome of all-cause mortality and/or hospitalisation for heart failure. Mean characteristics of articles included in data extraction were estimated by combined fixed-and random-effects meta-analysis. Z-scores for outcomes in sex were analysed using R software.

Results

Of 2188 articles identified through search, 26 articles and 103 746 patients [mean age 62±1.8 years, women 22.2%, mean LVEF 26.2±31.4%] were included in the meta-analysis. For all-cause mortality, there was a significant reduction in risk for men with HFrEF prescribed BB [HR 0.77 (0.69–0.86)] compared to no significant benefit in women [HR 0.87 (0.69–1.05)]; similarly there was a borderline significant reduction in risk for men with HFrEF prescribed RASi [HR 0.89 (0.78–1.00)] compared to no significant benefit in women [HR 0.80 (0.59–1.02)]. For the composite outcome of all-cause mortality and HF hospitalisation, there was significant reduction in risk in both women and men treated with BB (men [HR 0.73 (0.63–0.84)]; women [HR 0.74 (0.56–0.91)]); however significant risk reduction with RASi was observed in men [HR 0.82 (0.76–0.88)] but not women [HR 0.98 (0.86–1.09)]).

Conclusions

Our meta-analysis revealed potential sex differences in response to HFrEF therapies, where beneficial effects of RASi appeared more prominent in men compared to women. While mortality benefits with BB were also more prominent in men, reduction in the composite outcome of all-cause mortality and HF hospitalization with BB were evident in both men and women with HFrEF.

Effects of treatment on the outcomes

Funding Acknowledgement

Type of funding source: None
Safety of sacubitril/valsartan in heart failure outpatients with chronic heart failure in real life in Europe: results from ARIADNE registry
Authors: Zeymer U , Lund L.H , Barrios V , Fonseca C , Clark A.L , Damy T , Drozdz J , Kalus S , Koch C , Maggioni A
Published: November 2020

Background

Recently, the angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan was introduced as novel therapeutic option into European guidelines for the management of heart failure. The ARIADNE registry provides information about its safety and tolerability profile in real life in outpatients with heart failure with reduced ejection fraction (HFrEF) in Europe.

Methods

ARIADNE was a prospective registry of patients with HFrEF treated by office-based cardiologists or selected primary care physicians (recognized as HF specialists) in a real world setting. In total, 9069 HFrEF patients in 687 centres from 17 European countries were included and prospectively followed over 12 months. Here we report the safety information from 4614 patients that received sacubitril/valsartan at baseline.

Results

The mean age of patients was 67.3 years at baseline. The majority of enrolled patients were in NYHA class II or III (49.7% and 48.2%, respectively). Mean LVEF was 32.7% in the S/V group. Patients with S/V had arterial hypertension (62.5%), coronary heart disease (61.0%), dyslipidemia (50.6%), atrial fibrillation (41.0%), diabetes (34.3%), and chronic kidney disease (26.0%). Co-medications were beta-blockers (83.4%), MRAs (60.1%), loop diuretics (65.2%), and digitalis (7.5%).

S/V was discontinued due to an adverse event (AE) during the 12 months in 191 (4.1%) patients, of these in 180 (3.6%) due to AEs and 28 (0.6%) due to SAEs. The most frequent AE was hypotension, which was reported in 391 (7.9%) of patients, of these 74 (18.9%) discontinued S/V. Hypokalaemia was observed in 1.7% and an impairment of renal function in 1.0% of S/V patients, respectively. Total mortality was 3.8%, cardiovascular mortality 1.8% in the S/V group.

Conclusions

This is the first large prospective study on the use of S/V in patients with HFrEF in Europe. S/V was well tolerated with a safety profile comparable with that observed in clinical trials for S/V patients.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Cardiac rehabilitation effectively reduces the number of deaths in the heart failure population (propensity score matched analysis)
Authors: Leszek P , Witczak K , Bartolik K , Was D , Maruszewski B , Brukalo K , Kleinork A , Rolska-Wojcik P , Zaleska-Kociecka M
Published: November 2020

Background

Numerous cardiac rehabilitation (CR) studies have demonstrated functional benefits, improvement in quality of life and clinical outcomes from exercise training in patients with heart failure (HF), so CR is consistently recommend for HF patients. However its influence on survival in HF population is unknown.

Purpose

To assess the influence of CR on survival rate in HF patients.

Methods

It is a retrospective analysis of 1 620 686 HF patients in Poland in years 2013–2018, based on nationwide Polish Ministry of Health registry, that provides public universal healthcare coverage to all residents and collects detailed information for the entire Polish population (38,495,659 in 2013) since 2009. Within registry, we identified the experimental group of 11 512 HF patients ≥18 years old who underwent CR in 2013–2018.

From entire HF population we identified a 1:1 propensity score matched cohort of HF patients, who did not get CR.

Results

After propensity-score matching, we identified 11,512 patient pairs who underwent/not CR. Average age was approximately 66 years (18–39: 2.1 vs 2.0%; 40–49: 491 – 4.3 vs 4.2%; 50–59: 17.0 vs 17.1%; 60–69: 34.9 vs 35.2%; 70–79: 31.3 vs 31.4%; 80+: 10.4 vs 10.3% respectively), 61% of the participants were males, mainly urban residence nearly 70%, with HF diagnose put during hospitalization 74.5%. Both groups were similar also by comorbidities evaluated by Charlson Comorbidity Index.

Patients subjected to CR compared CR negative significantly increased survival risk at 1st, 2nd, 3rd, 4th and 5th year (CR vs CR negative 97.4% vs. 84.9%; 93.9% vs. 77.9%; 89.9% vs. 71.9%; 85.2% vs 66.0%; 81.8% vs 62.1% respectively) – Figure 1.

Conclusion

Our analysis showed that in heart failure patients, CR was associated with an increased survival rate among HF patients as treated in routine health care system.

Figure1

Funding Acknowledgement

Type of funding source: Other. Main funding source(s): European Union from the European Social Fund
Regular training in a hospital in patients with left ventricle assist device (LVAD): influence on exercise capacity, muscular strength and complex coordination
Authors: Smolis-Bak E , Chwyczko T , Noszczak E , Bogucki M , Zalucka L , Kowalik I , Mierzynska A , Piotrowicz E , Szymanski J , Zielinski T , Sobieszczanska-Malek M , Kusmierczyk M , Dabrowski R , Szwed H , Piotrowicz R
Published: November 2020

Heart failure (HF) significantly reduces physical capacity and harms the overall functioning. In the end-stage cases of HF, the only options are surgical procedures including left ventricular assist devices (LVAD) implantation and heart transplant. Due to the insufficient number of available organs for transplantation, LVAD are used more and more frequently. Rehabilitation of patients with LVAD is a crucial element of therapy because of long-term immobilization of patients awaiting transplant or heart muscle regeneration.

Purpose

The aim of the study was to evaluate the impact of early hospital rehabilitation on exercise tolerance, muscles strength and complex coordination in LVAD patients.

Methods

The total of 20 LVAD patients were recruited to the study (all male, aged 19–66 years). All patients underwent standard cardiac rehabilitation in the postoperative and medical treatment wards. After the end of hospitalization, patients were admitted to the rehabilitation department for 4–5 weeks. During that period they performed endurance training, conditioning exercises with elements of resistance and coordination exercises. All patients were tested before and after the rehabilitation program using ergospirometry (CPX), 6-MWT, upper and lower limbs muscle strength (30 Second Chair Stand) and complex coordination (Up&Go test).

Results

A significant increase in the values of most of studied parameters was observed after exercise training in comparison to the results before rehabilitation process (VO2 peak) [ml/kg/min]: 11.1±2.2 vs. 12.5±2.7, p<0.001; Watt: 42.6±12.4 vs. 54.1±13.1, p<0.0001; 6- MWT [m]: 300.1±102.2 vs. 404.8±105.9, p<0.0001; 30 Seconds Chair Stand [number of stands] 8.4±3.3 vs. 11.6±4.8, p<0.0001; Up&Go [sec] 9.0±1.7 vs. 7.1±1.5, p<0.0001; left hand grip strength [kg]: 31.5±8.4 vs. 34.8±8.1, ns; right hand grip strength [kg]: 33.6±11,2 vs. 36.0±9.0, ns. No adverse effects were observed during rehabilitation process.

Conclusions

Hospital-based rehabilitation is safe and effective in LVAD patients. Rehabilitation after LVAD implantation brings significant benefits in terms of exercise capacity and tolerance, muscle strength and complex coordination in this group of patients.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): NATIONAL RESEARCH AND DEVELOPMENT CENTER
A multiparametric ICD algorithm for heart failure risk stratification: an analysis in clinical practice
Authors: Calo L , Manzo M , Santini L , Dello Russo A , Santobuono V.E , Pecora D , Talarico A , Nicolis D , Costa A , Petracci B , Campari M , Valsecchi S , D'Onofrio A
Published: November 2020

Purpose

A novel multiparametric algorithm based on implantable cardioverter defibrillator (ICD) sensors has been recently developed. The HeartLogic index combines multiple parameters, i.e. heart sounds, intrathoracic impedance, respiration pattern, night heart rate, and patient activity, in a single index. In the validation study, the HeartLogic alert condition was shown to identify patients during periods of significantly increased risk of heart failure (HF) events. We sought to evaluate the risk stratification ability of the algorithm in a group of patients who received the system in clinical practice.

Methods

The HeartLogic feature was activated in 257 ICD and cardiac resynchronization therapy ICD patients (186 male, 70±11 years, left ventricular ejection fraction 30±8%) at 11 centers. The median follow-up duration was 14 months [25–75 percentile: 7–19]. The HeartLogic algorithm automatically calculates a daily HF index and identifies periods in or out of an alert state relative to a configurable threshold (in this analysis set to 16).

Results

Patients experienced 40 HF hospitalizations requiring at least 1 overnight stay (0.14/patient-year) during the observation period (285 patient-years). The HeartLogic index crossed the threshold value 191 times in 105 patients. The time in the alert state was 27 patient-years, i.e. 9.5% of the total observation period. HF hospitalization rate while in alert was 0.96/patient-year and 0.05/patient-year while out of alert. The occurrence of ≥1 index crossing during follow-up was associated with the risk of HF hospitalization (odds ratio: 4.70, CI 95%: 1.79–12.4, p=0.002), independently from other baseline clinical variables.

Conclusions

Our analysis of data collected in clinical practice confirms that the multiparametric ICD algorithm is an independent predictor of higher risk of HF. In particular, it allows dynamic identification of time-intervals when patients are at significantly increased risk of worsening HF. This potentially helps better triage resources to a more vulnerable patient population.

Funding Acknowledgement

Type of funding source: None