bluuebunny/crossref_metadata_2025 huggingface dataset:
The hemodynamic classification system for hemodynamic-related adverse events in left ventricular assist device patients
Authors: Gallone G , Baldetti L , Konicoff M , Ibero J , Maestro-Benedicto A , Morley-Smith A , Monteagudo Vela M , Fiorelli F , Frea S , Vandenbriele C , Panoulas V , Loforte A , De Ferrari G M , Garcia Saez D , Riesgo Gil F
Published: October 2024

Background

Durable left ventricular assist device (LVAD) physiology predisposes to right heart failure (RHF) and aortic insufficiency (AI), recently labelled hemodynamic-related adverse events (HDREs). However, the pathophysiology, incidence, and associated morbidity of HDREs remains largely unsettled due to heterogeneity in data reporting.

Purpose

We sought to validate the recently proposed LVAD Hemodynamic Classification System (HCS) for HDREs.

Methods

RHF and AI HDREs were retrospectively adjudicated, staged (mild to severe) and phenotyped (isolated or combined RHF/AI-HDREs) based on the HCS assessed at 6-month post-LVAD implant among 183 consecutive patients undergoing LVAD implant at a quaternary heart failure center, and either alive at 6-month on support (n=175) or deceased due to late HDREs 1 to 6 months post-LVAD implant (n=8). The primary outcome was a composite of first HF hospitalization or cardiovascular death between 6 and 24 months after LVAD-implant.

Results

At 6-month assessment, RHF-HDRE was adjudicated in all patients, while AI-HDRE could not be adjudicated in 22 (12.0%) patients. Overall, 53 (29.0%) patients developed an RHF-HDRE, and 26 (16.0%) an AI-HDRE (phenotypes: 39 isolated RHF, 15 isolated AI, 11 combined RHF-AI, 3 not-adjudicated). During pre-LVAD assessment, age and pulmonary artery pulsatility index were independently associated with RHF-HDRE; and pre-LVAD AI and systolic pulmonary artery pressure with AI-HDRE. Patients developing the combined RHF-AI phenotype required the most intensive bundle of critical care pre-LVAD implantation, had more frequent pre-LVAD RV dysfunction, the highest rate of early post-LVAD RHF, and the most prominent features of suboptimal left ventricular unloading, RV dysfunction, peripheral congestion, renal damage and impaired functional capacity at 6-month assessment. RHF-HDRE (adj-HR 2.69, 95%CI 1.14-6.34, p=0.024), AI-HDRE (adj-HR 4.21, 95%CI 1.70-10.40, p=0.002) and HDRE phenotype (isolated RHF or AI HDRE vs. no HDRE: adj-HR 2.80, 95%CI 1.03-7.62, p=0.044; combined RHF and AI HDRE vs. no HDRE: adj-HR 4.53, 95%CI 1.33-15.35, p=0.015) were associated with the primary outcome. A graded increase in primary outcome was observed with rising RHF and AI stages.

Conclusions

The LVAD Hemodynamic Classification System for HDREs identifies pathophysiological and clinical clusters of patients with significant prognostic implications. It may help the development of targeted strategies to mitigate HDREs and improve the success of long-term LVAD support.
Long-term outcomes of heart re-transplantation from HCV-viremic donors based on UNOS registry
Authors: Mazur M , Nunez M , Pisani B , Bhat G , Eisen H J
Published: October 2024

Background

The use of hepatitis C virus (HCV) viremic donors increased the heart donor pool, and reduced waitlist time and mortality among first-time single-organ heart transplant (HT) candidates without compromising their post-transplant survival. The outcomes of heart re-transplantation (re-HT) with the use of HCV-viremic donor grafts have not been investigated.

Methods

Using the United Network of Organ Sharing (UNOS) Registry we analyzed all adult patients who underwent single-organ heart re-HT in the United States between January 1, 2016, and December 31, 2022. HCV-viremic donors were defined by a positive nucleic acid amplification test (NAT+). Graft survival rates between HCV-viremic and HCV-non-viremic donor graft recipients were compared using a log rank test.

Results

During the study period, of 18,259 HTs performed, 427 (2.3%) constituted single-organ heart re-transplantations. Recipients of NAT+ grafts (n=19) compared to NAT- grafts (n=408) were more often male (84.2% vs 61.3%, p=0.04). Otherwise, there were no significant differences between the two groups in age, ethnicity, BMI, blood type, history of diabetes rates or stroke, creatinine or bilirubin levels, reason for re-HT, hemodynamics, use of mechanical circulatory support, and waitlist time. Ischemic time, frequency of female donors, HLA, ABO, CMV mismatch rates, and calculated panel reactive antibodies levels were comparable across the two groups. There were no significant differences in demographics or comorbidities rates between HCV-viremic and HCV-non-viremic donors apart from the cause of death. Among the donors of HCV-viremic grafts brain anoxia was reported more often (89.5%) than among HCV-non-viremic donors (40%), p <0.01. Rates of acute rejection treated in the first year after re-HT were comparable across the two groups. Over a mean follow-up of 3.0±2.1 and 3.3±1.8 years after re-HT from NAT- and NAT+ organ donors, respectively, graft survival rate at 1 year was 82% vs. 95% (p=0.3) and at 3 years 79% vs. 89%, respectively (p=0.6) (Figure).

Conclusion

Graft survival rates at 1 and 3 years post-heart re-HT in adult recipients of HCV-viremic donor grafts were comparable to those of recipients of HCV-non-viremic donor grafts. The current study provides compelling preliminary evidence that HCV-viremic donors constitute a viable donor pool for patients in need of heart re-transplantation.
Value-based versus usual care for heart failure patients leads to reduction in cost, hospital admissions and improved survival
Authors: Barbarash S B , Flores J , Zhu L , Cooper K , Siddiqui Y , Caraang C
Published: October 2024

Background

OptumCare (OC) in our city, Nevada established a heart failure (HF) program comprised of a team of outpatient cardiologists including two who are board certified in advanced heart failure. Referred patients are enrolled in the HF program once HF is diagnosed by a cardiologist. Patients are managed by an interdisciplinary team of cardiologists, advanced practice clinicians (APC), registered nurse case managers (RNCM), and a social worker. Patients at higher risk for HF admissions are enrolled in remote patient telemonitoring. In contrast, OC in Arizona utilizes a "usual" care approach of fee-for-service contracted cardiology groups to manage HF patients in outpatient and in-patient settings.

Purpose

A head-to-head comparison was performed between the cohort of patients enrolled in HF program in OC Nevada (treatment group) and patients with HF diagnosis in OC Arizona (control group). The groups were compared on the following measures: medical cost, hospital admissions, and survival rates.

Methods

In this retrospective study, a 1:1 iterative propensity score (PS) matching was performed to closely approximate patient demographics and comorbidities, which resulted in 818 matched pairs (total n=1,636) of the patients with program enrollment or 1st HF diagnosis between March 1, 2019 and June 30, 2022. For Difference-in-Difference Analysis (Diff-in-Diff), generalized linear models were used on PS matched data to test the difference in difference in medical cost and utilizations changes between control and treatment group over a six month period. Log-Binomial regression was used to estimate the relative risk of post period 30-day readmission and hospice enrollment. Kaplan Meier Estimator was used to test the difference in survival rates over time.

Results

Average age of patients was 77.6 years old, and 49% were female. The treatment group resulted in significantly lower overall medical costs per member per month (PMPM), significantly less emergency room (ER) visits, less acute hospital and skilled nursing facility (SNF) admissions, and shorter overall hospital length of stays. The control group was twice as likely to be readmitted to the hospital. Lastly, the treatment group had a significantly better survival rate than the control group. 19% of the patients in the control group expired within 12 months of enrollment vs. 10% of the patients in the treatment group expired during the same time period. Average survival was 142 days in the control group vs. 200 days in the treatment group.

Conclusions

A value-based care approach involving a multidisciplinary team in an outpatient-based cardiology HF program resulted in statistically significant improvement in medical costs, acute care visits/admissions, and survival rates compared to "usual" care approach for HF patients.
Who should be prioritized for screening for adult onset dilated cardiomyopathy among first degree relatives?
Authors: Oh J , Lee J Y , Lee C J , Kang S M
Published: October 2024

Introduction

Familial genetic and cardiovascular screening is highly recommended to detect dilated cardiomyopathy (DCM) in first-degree relatives (FDRs). Consequently, questions arise regarding the prioritization of screening among FDRs especially in Asian populations.

Purpose

To investigate prevalence and proportion of FDRs of DCM patients presenting with DCM.

Methods

Patients with DCM and their FDRs who underwent genetic counseling between April 2017 and March 2023 at a single tertiary center were retrospectively enrolled. The study collected baseline demographics and conducted sequential echocardiograms, along with genetic cascade sequencing for 36 genes clinically relevant to DCM. A positive DCM phenotype in FDRs was determined based on the presence of a decreased left ventricular ejection fraction (LVEF) with left ventricular enlargement, with a full phenotype containing both criteria and a partial phenotype containing either of them.

Results

A total of 122 probands (median age 59 years) and 241 FDRs (median age 43 years) participated in the study. Out of 72 FDRs (29.9%) with P/LP proband variants, only 18.6% of FDRs showed a positive DCM-phenotype. Overall, 29 individuals (15.5%) exhibited a positive DCM-phenotype, with 2.7% displaying a full DCM-phenotype and 12.8% displaying a partial DCM-phenotype. Among them, 69% exhibited heart failure (HF) with preserved EF, 20.7% had HF with mildly reduced EF, and 10.3% had HF with reduced EF. Siblings tended to be older compared to offspring (52.1 years vs. 35.5 years), aligning with the tendency shown in the more fulminant manifestation of the positive phenotype. Accordingly, a higher prevalence was observed among siblings (n=4, 80%) with a full phenotype and in those with a partial phenotype.

Conclusion

This study demonstrated higher prevalence of phenotype-positive DCM among siblings of probands. Given disease’s manifestation in adulthood, it is essential to prioritize the screening of all FDRs with emphasis on the siblings.
Relationship between chronic obstructive pulmonary disease and heart failure hospitalization in patients with atrial fibrillation: the Fushimi AF Registry
Authors: Ishii M , Ishigami K , Ikeda S , Doi K , Yoshizawa T , Hamatani Y , Ide Y , Fujino A , Iguchi M , Masunaga N , Esato M , Wada H , Hasegawa K , Abe M , Akao M
Published: October 2024

Background

Chronic heart failure and chronic obstructive pulmonary disease (COPD) are both common diseases and often co-exist. Patients with COPD are at increased risk for hospitalizations due to cardiovascular diseases. However, in patients with atrial fibrillation (AF), the relationship between COPD and the risk of heart failure (HF) hospitalization remains unclear.

Purpose

The purpose of this study was to investigate the relationship between COPD and HF hospitalization in AF patients.

Methods

The Fushimi AF Registry, a community-based prospective survey, was designed to enroll all of the AF patients in Fushimi-ku, Japan. Fushimi-ku is densely populated with a total population of 283,000 and is assumed to represent a typical urban community in Japan. We started to enroll patients from March 2011, and follow-up data were available for 4,496 patients by the end of February 2022. We compared patients with and without COPD with regard to clinical background and HF hospitalization during follow-up period.

Results

In this cohort, the proportion of pre-existing HF among patients with COPD was 30.1%, and the proportion of COPD among patients with pre-existing HF was 5.9%. Of 4,496 patients, 238 (5.3%) patients had COPD (COPD; the mean age 75.6 years, female 20.6%), and the remaining 4,258 patients did not (Non-COPD; the mean age 73.5 years, female 41.6%). Patients with COPD were older than those without COPD. However, the proportions of patients with pre-existing HF, previous stroke, vascular disease, cardiomyopathy, coronary artery disease (CAD), diuretic use, renal dysfunction, diabetes mellitus (DM) and hypertension were comparable. During the median follow-up period of 1,824 days, the incidence of HF hospitalization was significantly higher in COPD than in Non-COPD (COPD vs. Non-COPD; 4.85% vs. 3.01% per person-year: p<0.01). In multivariate analysis adjusted by sex, age (≥ 75 years), heart disease (combined by heart failure, vascular disease, cardiomyopathy and CAD), renal dysfunction, DM, hypertension and diuretic use, COPD was an independent risk factor for HF hospitalization (hazard ratio (HR) 1.54, 95% confidence interval (CI) 1.15-2.07, P<0.01) (Figure 1). When we analyzed patients without pre-existing HF, the incidence of HF hospitalization was also significantly higher in COPD than in Non-COPD (COPD vs. Non-COPD; 2.87% vs. 1.75% per person-year: p=0.02). In multivariate analysis after adjusting for the same factors, COPD was an independent risk factor for HF hospitalization (HR 1.63, 95% CI 1.05-2.53, P=0.03) (Figure 2).

Conclusion

In patients with AF, COPD was the risk of HF hospitalization. The results were consistent in AF patients without pre-existing HF.
A graded association between mobility limitation and prognosis in patients with heart failure
Authors: Iwatsu K , Takabayashi K , Hamada T , Kubo T , Ikeda T , Kitaguchi S , Kimura T , Kitaoka H , Nohara R
Published: October 2024

Background

In the era of an aging population worldwide, geriatric conditions have become a high-priority clinical concern in treating heart failure (HF). Although mobility limitation is one of the most common geriatric conditions, no study has quantified the dose-response relationship between the level of mobility limitation and the risk of adverse clinical outcomes in patients with HF.

Purpose

This study aimed to characterize the association between the level of mobility limitation and prognosis in patients with HF.

Methods

This study was conducted as a patient-level pooled analysis of data from two prospective multicenter cohort studies. The analysis included consecutive patients hospitalized for HF without any exclusion criteria, with a total of 2103 participants. We categorized the patients into four groups based on their level of mobility limitation: Category I, independent outdoor walking; Category II, independent indoor walking; Category III, indoor walking with assistance; and Category IV, abasia. The primary endpoint was a 2-year composite outcome of re-hospitalization for HF or all-cause mortality after hospital discharge.

Results

During the 2820.7 person-year follow-up period, 998 patients experienced the composite outcome. The cumulative incidences of the composite outcome for Categories I to IV were 24.9, 47.0, 59.3, and 84.8 per 100 person-years, respectively (Figure). After adjusting for potential confounders, a 1-point increase in the mobility limitation category was associated with a 19% higher risk of the composite outcome (hazard ratio: 1.19; 95% CIs: 1.10–1.29; p<0.001).

Conclusions

A strong and graded association exists between the level of mobility limitation and prognosis in patients with HF. Even among patients with mobility limitations, the risk of adverse clinical outcomes varies in a dose-response manner depending on the magnitude of mobility limitation. Our findings contribute to a more individualized approach for managing older patients with HF.Figure
The role of malnutrition and dependence on outside help in hospitalized elderly patients with decompensated heart failure
Authors: Al-Autairi A , Moiseeva A Y , Gurbanova L F , Galochkin S A , Kotova E O , Kobalava Z D
Published: October 2024

Introduction

Despite recent achievement in the diagnosis and treatment of heart failure, the prognosis for disease remains unfavorable especially in elderly patients. It has been recently actively proposed to introduce a comprehensive geriatric assessment to determine the group of adverse outcome and frailty, however the assessment of geriatric syndromes in acute decompensated heart failure (ADHF) among hospitalized patients is poor.

Aim

To assess the prognostic role of malnutrition and dependence on outside help in hospitalized elderly patients with ADHF.

Materials and methods

The study included 60 patients over 75 years old who were hospitalized for ADHF. The median [IQR] age was 83.0 [77.0-87.0] years, 41.7% (n=25) were men. The preserved left ventricular ejection fraction (LVEF) prevailed – 51.2% (n=22), moderately reduced and low LVEF – 23.3% (n=10) and 25.6% (n=11), respectively. Total/severe dependence on outside help was determined with Barthel Index of ≤60 points, malnutrition – with a Mini Nutritional Assessment Scale of <17 points, sarcopenia with SARC-F ≥4 points. At discharge, all patients underwent bioimpedance analysis of body composition (BIA). The primary endpoint was hospital mortality.

Results

48.3% (n=29) of hospitalized elderly patients with ADHF had total/severe dependence on outside help. This group of patients had a higher risk of malnutrition (OP 2.01, 95% CI 1.49-2.83, p=0.04) and sarcopenia (OP 8.25, 95% CI 1.55-44.02, p=0.01).

Elderly patients with ADHF and malnutrition had a more severe functional class (NYHA III-IV) than patients without malnutrition (97.1% vs. 66.7%, respectively, p=0.02). There were no differences in ADHF phenotypes depending on the presence of malnutrition.

The ability to self-serve according to Barthel Index has positively correlated with the BIA Index (r=0.483, p=0.04). The risk of sarcopenia on the SARC-F scale has negatively correlated with fat, lean and active cell mass according to BIA (r=-0.538, r=-0.599 and r=-0.532, respectively, p<0.05).

Elderly patients with ADHF and a combination of total/severe dependence on outside help and malnutrition (27.9%, n=12) had higher inflammation level (neutrophil-lymphocytic index 5.6 [2.6-7.7] vs. 3.9 [2.0-6.0], p=0.03, respectively) and the need for longer intravenous diuretic therapy (OP 4.38, 95% CI 1.21-15.81, p=0.03) compared with patients without these disorders (72.1%, n=31), The primary endpoint was reached by 4 patients, in 100% of cases there was a combination of total/severe dependence on outside help and malnutrition.

Conclusion

The combination of total/severe dependence on outside help and malnutrition is an unfavorable prognostic marker of hospital mortality in hospitalized elderly patients with ADHF. A comprehensive geriatric assessment and determination of body composition can identify a risk group for an adverse outcome.
Anemia and sideropenia in patients with decompensated heart failure
Authors: Mikic L , Stevic J , Babic M , Popovic D , Markovic Nikolic N
Published: October 2024

Introduction

Anemia is highly prevalent in patients with heart failure (HF). In the latest ESC guidelines, intravenous. iron supplementation is recognized as substantial for improving quality of life, exercise capacity and reducing the risk of future hospitalizations in patients diagnosed with HF of reduced ejection fraction (HFrEF). We hypothesized that patients diagnosed with HF of preserved EF (HFpEF) and midly reduced EF (HFmrEF), who also exhibit iron deficiency, may benefit from intravenous iron supplementation.

Method

We evaluated the prevalence and parameters of anemia from medical histories of hospitalized patients with HFrEF and HFmrEF/HFpEF, from March 2023 to January 2024, and compared them to NTproBNP levels.

Results

We included 134 hospitalized patients with HF, mean age 71 ± 10 (41% women). Of total 134, 77 patients exhibited acute worsening of chronic HFrEF or were newly diagnosed HFrEF (group A), whereas 57/134 patients had decompensated HFmrEF/HFpEF (11 and 46, respectively - group B) whose iron status was analyzed on admission. General prevalence of anemia in all HF patients was 50.8% (cut off value - hemoglobin concentration less than 12 g/dL in women, and less than 13 g/dL in men), 54.4% of HFpEF/HFmrEF group and 48.1% of HFrEF group had anemia, 46.6% patients with anemia had EF>40%, without any statistical difference among groups (hemoglobin concentration group A/group B – 12.33±2.54/11.89­±2.63 g/dL, CV 0.2). Reduced transferrin saturation, which is defined as less than 20.0%, had 44.0% of all HF patients, and that was more common in HFrEF patients (62.0%), but statistically insignificant (group A/group B - 0.1843±0.10/0.1877±0.11, CV 0.6). Among group A and group B - 63.6% and 62.5% had transferrin saturation less than 0.2, respectively. There was no difference in the prevalence of serum ferritin <100 μg/L in group A and B (41.6% and 47.4% respectively; group A/group B – 177.26±176.7/137.01±126.6, CV 0.9).

Spearman’s rank test implied no correlation between NTproBNP levels and serum ferritin or transferrin saturation. Serum iron had a mild negative (coefficient -2.8) correlation with NTproBNP levels (p<0.01). Hemoglobin concentration was associated with strong negative correlation with NTproBNP levels but with less statistical significance (coefficient -0.9 p<0.05).

Conclusion

Results of our study suggest that anemia and sideropenia are common in our HF population, with no difference between the spectrum of HF subgroups based on EF. There seems to be a correlation between anemia and serum iron and level of NTproBNP which may imply that anemia and low iron worsen the degree of HF decompensation.
Comparing de novo heart failure and acute decompensated heart failure using a proteomic approach
Authors: Dieden A , Holm H , Korduner J , Nezami Z , Zaghi A , Bachus E , Molvin J , Gudmundsson P , Jujic A , Magnusson M
Published: October 2024

Background

Acute heart failure (HF) is defined as new or worsening symptoms of HF and stands as the most common cause of unscheduled hospital admission in patients above the age of 65. Acute HF can be classified into de novo HF (DNHF), defined as no previous history of HF, and acutely decompensated HF (ADHF), defined as worsening symptoms of HF in individuals with a prior diagnosis of HF. Clinically, it is relevant to distinguish ADHF from DNHF as they differ regarding aetiology, comorbidities, mortality, and morbidity. The aim of this study was to compare DNHF and ADHF using a proteomic approach.

Method

Using a proximity extension assay in a Swedish HF cohort, a total of 324 individuals hospitalized for acute HF underwent proteomic analysis of 92 proteins. The population was categorized into DNHF and ADHF, subsequently comparing normally distributed proteins using an independent samples t-test. Non-normally distributed proteins were compared using the Mann-Whitey U-test. To adjust for multiple testing, Benjamini Hochberg method was applied with a false discovery rate of 5%. Fold change was calculated by subtracting the mean or median protein concentration in ADHF from DNHF. As protein concentrations are expressed on a log2-scale, the difference between the groups equals the fold change. Proteins were considered differentially expressed at a fold change threshold of 1.15. The proteins that met a cut-off, were thereafter analysed with a pathway enrichment analysis using Reactome (only a corrected p-value ≤0.05 was considered significant).

Results

Complete data was available for n=317 (30.3% women; mean age 74.6) individuals (Table 1). After FDR adjustment, differential protein expression analysis yielded 56 differentially expressed proteins. After applying the fold change threshold, 51 proteins were significantly up regulated in ADHF compared to DNHF and one (Paraoxonase 3) was significantly downregulated. The most prominently up-regulated protein was fatty acid binding protein-4 (FABP4) (fold change 1.68, p <0.001). The largest number of proteins were related to neutrophil degranulation (Figure 1).

Conclusion

In patients hospitalized for acute HF, we identified several common pathways of the proteins differentially expressed in DNHF compared with ADHF. Neutrophil degranulation was related to the largest number of proteins. The most prominently up regulated protein was FABP4. These findings may inspire future investigation into the different underlying molecular mechanisms in ADHF and DNHF and reveal potentially different targets of treatment between the two conditions.Figure 1.Pathway enrichment analysis
High infection prevalence in patients who develop severe acute kidney injury during heart failure hospital admission
Authors: Tumelty E , Chung I , Leung N , Hillingdon K , Addada H , Mandarano L , Anderson L , Banerjee D
Published: October 2024

Background

Acute kidney injury (AKI) is common in acute HF and associated with poor prognosis. (1-3) The cause of AKI is often unknown.

Purpose

The aim of this analysis was to analyse the data for patients with a severe AKI which developed during a HF admission and identify potential triggers in the preceding 7 days (e.g., infection, hypotension, contrast agents.).

Methods

Data between January 2022 to March 2023 was obtained from that submitted by our centre to the mandatory National HF Audit which collects data from every patient admitted with acute HF. For this analysis, baseline renal function was retrospectively collected from electronic patient records, and chronic kidney disease and AKI were subsequently defined, as per KDIGO guidelines(4), using baseline and admission measurements. Electronic patient records were reviewed for all patients who developed AKI stage 2/3 ≥48 hours after admission. Data collected during the week prior to their AKI included any radioiodine contrast exposure, temperature ≥ 38⁰C, antibiotics, CRP >100mg/L and periods of sustained hypotension.

Results

Of the 843 HF hospital admissions between January 2022 and March 2023, 507 (60.1%) were not associated with AKI [inpatient (IP) mortality 5.9%], 237 (28.1%) had an AKI stage 1 [IP mortality 17.3%], 51 (6.0%) had an AKI stage 2 [IP mortality 25.5%] and 48 (5.7%) had an AKI stage 3 [IP mortality 33.3%]. The age, diabetic status and ejection fraction of patients was similar across AKI stages.

Of these, 64 patients developed their AKI stage 2 (n=30) or 3 (n=34) on or after their second day of HF hospital admission. 22 (34.3%) of these patients died during this admission, and 37 (57.8%) had died after a median follow-up of 217.5 days (IQR 24-331.75) (Table 1).

71.9% had evidence of an infection (defined by a temperature spike ≥38⁰C, received antibiotics, OR CRP >100mg/dL) in the week prior to developing their AKI (Table 2). 39% of patients had received a contrast agent in the preceding week, and 39% had experienced persistent hypotension in the preceding 48 hours. 25% had 2 of these potential triggers, 17.2% had 3. Six patients (9.4%) had no apparent identifiable triggers. 25% had not had renal function checked for 48h prior to AKI.

Conclusion

The most frequent identifiable potential trigger for severe AKI was infection in 72%, followed by contrast agent (39%) and hypotension (39%). Many patients had multiple triggers. Over-diuresis in isolation was not identified as a trigger for AKI in this cohort. Severe AKI 2/3 is a marker of extreme mortality risk and identifies patients in need of intensive monitoring. Lack of daily bloods in one quarter of patients led to a delay in AKI alert. Close observation for all acute HF patients including daily bloods and early identification and treatment of infection plus judicious and least use of contrast is needed to reduce the high mortality rates in this population.
VExUS score improvement is associated with better outcomes in acute decompensated heart failure
Authors: Saadi M , Silvano G P , Telo G H , Scolari F L , Machado G P , Almeida R F , Biolo A , Silveira A D
Published: October 2024

Background

Venous Excess Ultrasound Score (VExUS) has recently emerged as a non-invasive tool for venous congestion assessment in acute decompensated heart failure (ADHF). Although VExUS is associated with cardiorenal syndrome, the prognostic role regarding hard outcomes in ADHF is still unknown.

Purpose

To evaluate whether dynamic changes in VExUS within 72 hours after Cardiovascular Intensive Care Unit (CICU) admission is associated with in-hospital mortality in ADHF patients.

Methods

Prospective cohort study enrolling consecutive patients with ADHF admitted to CICU of a tertiary public hospital. VExUS evaluations ranging from 0 (no congestion) and 3 (severe congestion) and assessing the inferior vena cava, hepatic, and portal veins flow, were initially performed within 24 hours of admission and re-evaluated at 72 hours (third day) after treatment initiation. Changes in VExUS scores were compared between these two time points. Mann-Whitney test and logistic regression was performed to evaluate VExUS improvement association with mortality.

Results

Between October 2022 and January 2024, 81 patients were admitted to the CICU due to ADHF. Following the exclusion of 10 patients who were not assessed within the first 24 hours, 71 patients were included in the final analysis. Mean age was 65 ± 13.3 years, with 66.7% being male. Ischemic etiology was identified in 40.7%, and atrial fibrillation was present in 34.6%. Mean left ventricular ejection fraction was 27.4% ± 12.2, and 64.2% had right ventricular dysfunction. Upon admission, 73.2% were classified as B and 23.9% as C hemodynamic profiles. Overall in-hospital mortality was 25.9%. In-hospital mortality across VExUS categories assessed in the third day was 16.7%, 12.5%, 28.6% e 40%, for VExUS 0-3, respectively. The median VExUS variation between the two time points was greater in patients who survived [-1 vs. 0; p=0.030] and VExUS improvement at 72 hours was associated with a 46% decrease in hospital mortality for each class reduction (OR=0.536; 95% CI 0.29-0-81; p=0.043 - Figure 1).

Conclusion

Improvement in VExUS score between admission and 72 hours is associated with reduced in-hospital mortality. This finding highlights the potential role of dynamic VExUS monitoring for identifying delayed treatment response patients. Thus, changes in VExUS emerged as a prognostic tool offering a pathway to potentially intensify treatment strategies for high-risk patients with ADHF.VExUS score changes within 72 hours
Prognostic implications of microvascular resistance reserve in symptomatic patients with intermediate coronary stenosis
Authors: Lee J M , Lee S H , Choi K H , Hong D , Shin D , Joh H S , Kim H K , Park T K , Yang J H , Song Y B , Hahn J Y , Choi S H , Gwon H C
Published: October 2024

Background

Microvascular resistance reserve (MRR) is a novel index reflecting coronary microcirculatory function, irrespective of epicardial coronary artery stenosis. There is limited evidence regarding whether MRR can be an independent prognostic tool in patients with stable ischemic heart disease (IHD).

Objective

To evaluate clinical outcomes according to MRR in patients with stable IHD accompanied with or without significant epicardial coronary artery stenosis.

Methods

The current study included 547 consecutive patients undergoing systematic echocardiographic and invasive physiologic assessment for suspected stable IHD. Significant epicardial coronary artery stenosis was defined as fractional flow reserve (FFR)≤0.80. Coronary microvascular dysfunction (CMD) was defined as MRR≤3.0. Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction, repeat revascularization, and admission for heart failure.

Results

Among the total patients, 172 patients (31.4%) had FFR≤0.80 and 200 patients (36.6%) had CMD defined by MRR≤3.0. MRR showed no significant correlation with FFR (R=-0.031, P=0.469), however, it was significantly correlated with index of microcirculatory resistance (R=-0.353, P<0.001), NT-proBNP (R=-0.296, P<0.001), left ventricular filling pressure (E/e’) (R=-0.224, P<0.001), and diastolic dysfunction grade (P<0.001). During median follow-up of 3.3 years (interquartile range from 2.0 to 4.5 years), MRR was significantly associated with MACE risk (HR 1.23 per-1 decrease, 95% CI 1.12-1.36, P<0.001). CMD defined by MRR≤3.0 was associated with an increased MACE risk in both FFR>0.80 (41.0% vs. 26.0%; HRadj 1.59, 95% CI 1.07-2.35, P=0.021) and FFR≤0.80 (34.7% vs. 14.8%; HRadj 2.32, 95% CI 1.12-4.82, P=0.024) groups.

Conclusion

Decreased MRR was associated with the presence of cardiac diastolic dysfunction as well as with increased left ventricular filling pressure. The presence of CMD defined by MRR was independently associated with the risk of a composite of cardiovascular death, myocardial infarction, repeat revascularization, and admission for heart failure in patients with stable IHD, irrespective of significant epicardial coronary artery stenosis.
Association between high versus low cardiovascular risk in individuals with corresponding unexpected absent versus severe subclinical coronary atherosclerosis, a nationwide, multicenter study
Authors: Johansson M , Hagstrom E , Jernberg T , Soderberg S , Ostgren C J , Bergstrom G , Engstrom G , Gottsater A , Nilsson P M
Published: October 2024

Background

It remains unclear as to why some individuals at low risk of cardiovascular disease (CVD) develop severe coronary atherosclerosis, while those at high CVD risk may remain free from coronary atherosclerosis.

Purpose

Using Coronary Computed Tomography Angiography (CCTA), we aimed to identify factors associated with absence and severe coronary atherosclerosis in subjects from the general population with very high and low-moderate CVD risk, respectively.

Methods

We assessed cross-sectionally a nationwide, multicenter population-based cohort, consisting of 30,154 individuals randomly recruited from the general population (age range 50-64 years, 51.4% women). Coronary calcified plaque burden was estimated by coronary artery calcium score (CACS) assessed by CCTA. Absent coronary atherosclerosis was defined as CACS 0 and severe coronary atherosclerosis was defined as CACS ≥301. We investigated only individuals with low-moderate (<5%) and very high CVD risk (≥10%) according to SCORE2 were included. Individuals with CACS 0 and prevalent CVD were excluded, as well as those with moderate CACS (1-300) or SCORE2 risk 5-9%. Out of 26 722 subjects with complete data on CACS and SCORE2, 13 075 were included. Logistic regression was performed adjusted for age and sex.

Results

The overall distribution of CACS in relation to SCORE2 CVD risk is illustrated in the Figure. Study characteristics are displayed in Table 1. Severe-extensive CACS in combination with low-moderate CVD risk was present in 2.3% (n=296). A further 2.3% (n=311) had very high CVD risk but CACS 0.

Factors associated with CACS 0 despite a very-high estimated CVD risk included: lower age, being female, being born in Sweden, not having hypertension or hyperlipidemia, fewer pack-years of smoking, and lower waist circumference in men.

On the contrary, severe-extensive CACS despite a low-moderate estimated CVD risk was associated with higher age, being male, being an ex-smoker, reporting more pack-years of smoking, having higher HbA1c, higher BMI, higher waist circumference, and prevalent hyperlipidemia and hypertension (Table 2).

Conclusions

We identified extreme cardiovascular risk phenotypes (subgroups) in the general population that either lacked coronary calcifications despite being at very high estimated CVD risk or had severe subclinical coronary atherosclerosis despite being at estimated low-moderate CVD risk. Further studies are warranted to elucidate putative enhancing or protective mechanisms explaining this unexpected phenomenon.
Relationship between coronary atherosclerotic lesion and arterial stiffness in patients with coronary artery disease
Authors: Yusupalieva D , Shek A , Nizamov U
Published: October 2024

Introduction

Some of the previous studies demonstrated that arterial stiffness independently predicts mortality and morbidity associated with CAD.

Purpose

to evaluate the relationship between coronary atherosclerosis severity and arterial stiffness.

Material and methods

The study included 158 people aged 40 to 70 years: control group – 25 people (mean age 61,7±6,6 years; 21 men and 4 women) without cardiovascular diseases (CVD) and 133 patients (mean age 62,5±6,9 years; 80 men and 53 women) with CAD, confirmed by coronary angiography (CAG). Arterial stiffness was assessed using applanation tonometry (AT). Аssessment of the coronary calcium (CC) was performed with computer tomography (CT).

Results

In 133 patients with CAD, the results of AT were compared with the degree of atherosclerotic lesion according to CT and CAG data. All patients were divided into groups depending on the CC value. Group I included 19 people with a CC value of 0, group II - 55 people with a CC of up to 400, and group III - 59 patients with a CC of more than 400. With an increase in the degree of the atherosclerotic lesion, the values of peripheral and central pulse pressure (PP), augmentation index (AIx), additional augmentation index normalised for heart rate of 75 bpm (AIx@HR75) and pulse wave velocity (PWV) statistically significantly increased (Table 1). Indicators characterising augmentation of сentral PP and arterial stiffness also increased.

Conclusion

Increases in Pulse Pressure, Augmentation Index, and Pulse Wave Velocity reflect the worsening of atherosclerosis in coronary arteries, thereby indicating a higher risk of cardiovascular complications. Monitoring of these parameters can be crucial for early diagnosis and prevention of major adverse cardiovascular events.
Gender differences in the use of coronary computed tomography angiography, functional testing, coronary angiography, revascularization, and outcomes - a 10-year Danish, nationwide, registry-based foll
Authors: Lauridsen C , Meller Soendergaard M , Dupont Rasmussen L , Hylgaard Joergensen S , Torp-Pedersen C , Eftekhari A , Hay Kragholm K
Published: October 2024

Background and aims

Coronary computed tomography angiography (CCTA) serves as a noninvasive imaging modality, that guides downstream preventive and invasive treatment. However, differences in its use in relation to gender has not been investigated.

Methods

This nationwide register-based cohort study investigated all residents in Denmark between 2008 and 2018, consisting of individuals aged 50-80 years without coronary artery disease (CAD). The study population was stratified into male and female cohorts (n = 1469724). The outcomes included CCTA, functional testing, invasive coronary angiography (ICA), myocardial infarction (MI), revascularization, and major adverse cardiovascular and cerebrovascular events (MACCE).

Results

Among individuals who underwent CCTA, a slightly higher use was observed among females (absolute risk [AR] 4.2% individuals aged ≥50-59 years, AR 4.1% individuals aged ≥60-69 years, and AR 2.3% individuals aged ≥70-80 years) compared to males (absolute risk [AR] 4.0% individuals aged ≥50-59 years, AR 3.6% individuals aged ≥60-69 years, and AR 2.3% individuals aged ≥70-80 years). Conversely, the use of functional testing, were lower among females (AR 4.5% individuals aged ≥50-59 years, AR 5.2% individuals aged ≥60-69 years, and AR 4.3% individuals aged ≥70-80 years) compared to males (AR 6.2% individuals aged ≥50-59 years, AR 7.1% individuals aged ≥60-69 years, and AR 6.3% individuals aged ≥70-80 years), similar differences were observed for ICA, revascularization, MI risks, and MACCE.

Conclusion

Men were less likely to undergo CCTA compared to women. Conversely, use of functional testing, ICA, and revascularization along with an increased risk of MI or MACCE were higher in men.Figure 1
Rivaroxaban or warfarin in atrial fibrillation and coronary stent implantation in real-world patients involving chronic kidney disease (REWRAPS): 5-year follow-up study
Authors: Ozaki Y , Kawai H , Muramatsu T , Valgimigli M , Ismail T F , Watarai M , Ajioka M , Shimizu K , Oguri M , Kondo T , Morishima I , Takahashi H , Amano T , Izawa H , Murohara T
Published: October 2024

Background

Recent guidelines recommended either non vitamin K antagonist oral anticoagulants (NOAC) or vitamin K oral anticoagulant (VKA) one year after coronary stenting in patients with atrial-fibrillation (AF). However, whether NOAC is still superior to VKA at 5-years in patients involving chronic kidney disease (CKD) with AF and coronary stenting >1-year remains unclear.

Methods

In a multicenter, prospective, non-randomized registry, 493 patients were treated with either rivaroxaban or warfarin, while the majority (66.3%) of them had CKD. The primary efficacy endpoint was major adverse cardiac and cerebral events (MACCE). The primary safety endpoint was major bleeding (Bleeding Academic Research Consortium [BARC] 3 and 5). Net adverse clinical events (NACE) were defined as the composite of all-cause mortality and major bleeding. Both crude and propensity score matched (PSM) analyses were performed. P <0.05 was considered as statistically significant.

Results

At a median follow-up of 4.8 years MACCE rates did not differ between rivaroxaban and warfarin in 486 patients with crude-analysis (23.0% versus 29.0%, hazard-ratio [HR], 0.79; 95% confidence interval [CI], 0.55 to 1.11; P=0.17), while in 316 patients with PSM-analysis rivaroxaban met non-inferiority criteria to warfarin (HR, 0.86; 95% CI, 0.56 to 1.33; p=0.020 for non-inferiority). Rivaroxaban was associated with lower major bleeding risk compared with warfarin (6.5% versus 12.6%; HR, 0.50; 95% CI, 0.27 to 0.91; P=0.025) at crude analyses, which was no longer significant at PSM analyses (5.7% versus 10.8%; HR, 0.53; 95% CI, 0.24 to 1.19; P=0.12). However, NACE rates were significantly lower in rivaroxaban compared to warfarin at both crude (19.0% versus 35.7%; HR, 0.50; 95% CI, 0.35 to 0.72; P=0.0002) and PSM-analyses (19.6% versus 31.0%; HR, 0.63; 95% CI, 0.40 to 0.98; P=0.043), respectively.

Conclusions

Rivaroxaban did not differ from warfarin for efficacy endpoints of MACCE but was associated with lower NACE rates (i.e. all-cause mortality and major bleeding) in AF and coronary stent in real-world patients having CKD at 5-year follow-up (NCT02024230).
Anticoagulant monotherapy versus anticoagulant therapy in combination with single antiplatelet agent in patients after coronary artery bypass grafting - analysis of real-world data
Authors: Segiet-Swiecicka A , Dabrowski R
Published: October 2024

Introduction

Among patients undergoing coronary artery bypass grafting (CABG), in a significant group chronic anticoagulant treatment is indicated. Current recommendations from scientific societies do not clearly indicate the optimal antithrombotic treatment strategy in this group of patients. Addition of antiplatelet therapy recommended after CABG to chronic anticoagulant therapy increases the risk of bleeding complications, however, efficacy of antithrombotic treatment strategies has not been compared in large prospective studies.

Purpose

The aim of the study was to compare the efficacy and safety of post-CABG antithrombotic treatment strategies in patients after CABG with coexisting indications for chronic anticoagulant treatment, based on the analysis of the real-world database.

Methods

Real-world data from the THIN database were analyzed. The population included adult patients from France and Great Britain undergoing CABG between 2010 and 2022 who were treated with anticoagulants within a year after CABG and who were followed for at least one year after CABG or until death. The endpoints were compared between groups of patients treated with anticoagulants in monotherapy (VKA or NOAC) (MT) and patients treated with anticoagulants (VKA or NOAC) in combination with antiplatelet agent (ASA or oral P2Y12 inhibitor) (CT). The primary efficacy endpoint was the occurrence of major adverse cardiac events (MACE), the primary safety endpoint was major bleeding and the secondary safety endpoint was death from any cause.

Results

A database query obtained records of 3500 patients meeting the inclusion criteria, but due to missing data, 710 patients were included in the analysis. In this group, 193 (27.2%) patients were in MT group, and 517 (72.8%) in CT group. The majority (87.0%) were men, the mean age was 72.8 (9.4) years. The MACE occurred in 19.2% patients in the MT and in 19.3% in the CT. There was no significant effect of antithrombotic treatment strategy on time to event (log-rank test p=0.553) and on risk of MACE occurrence (HR 0.89 (95% CI 0.61 - 1.31) for CT vs. MT). The major bleeding occurred in 6.2% patients in the MT and in 10.3% in the CT and no significant effect of group was observed (log-rank test p=0.170, HR 1.55 [95% CI 0.83 - 2.90] for CT vs. MT). The death from any cause occurred in 10.9% patients in the MT and in 10.1% in the CT and no significant effect of group was observed (log-rank test p=0.174, HR 0.70 [95% CI 0.42 - 1.17] for CT vs. MT).

Conclusions

The results indicate the comparable efficacy and safety of both antithrombotic treatment strategies: anticoagulants in monotherapy versus anticoagulants in combination with antiplatelet agent in the group of patients after CABG with coexisting indications for chronic anticoagulation.
Clinical impact of perfusion balloon for ST-segment elevated myocardial infarction: RYUSEI study
Authors: Nishino M , Egami Y , Nakamura H , Abe M , Ohsuga M , Nohara H , Kawanami S , Ukita K , Kawamura A , Yasumoto K , Tsuda M , Okamoto N , Matsunaga-Lee Y , Yano M
Published: October 2024

Background

Drug-eluting stents have significantly contributed to reducing mortality in patients with ST-segment elevation myocardial infarctions (STEMIs), but slow flow/no-reflow phenomenon and in-stent restenosis are still clinical problems. On the other hand, perfusion balloons (PBs) can compress thrombi and ruptured plaque for long inflation without ischemia and can be used as a delivery device for infusion of nitroprusside to distal risk area during ballooning.

Purpose

We conducted RYUSEI (Reduction of risk bY perfUsion balloon for ST-segment Elevated myocardial Infarction) study to evaluate whether PBs before stenting are more effective than conventional stenting for STEMIs.

Methods

We divided consecutive patients with STEMIs who underwent optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) into PB group who were treated with PBs before stenting and the conventional PCI (CP) group. In PB group, we inflated PB at the culprit lesion for five minutes to compress thrombi and ruptured plaque as a pre-stent lesion modification. In addition, an intra-coronary injection of nitroprusside (total dose: 120 µg; slow bolus injection of 24 µg/5mL every minute [5 times]) into the distal vascular bed to the culprit lesion through the PB was performed during a 5-minute PB ballooning. We compared clinical results including slow flow/no-reflow phenomenon, OCT findings, and one-year clinical events including cardiac death, target vessel-related myocardial infarctions, target lesion revascularization and stent thromboses between the two groups.

Results

We finally analyzed 34 patients in PB group and 90 in CP group. After propensity score matching, PB and CP groups consisted of 23 patients, respectively. In the propensity score-matched cohort, there were no significant differences of the patients’ backgrounds and lesion and procedural characteristics between the two groups. In the cohort, regarding post PCI angiographic and OCT findings, the incidence of slow flow/no-reflow phenomenon and maximum protrusion area detected by OCT were significantly lower (P=0.047 and P=0.019, respectively) and TIMI flow grade 3 was significantly higher (P=0.022) in the PB group than CP group while the other parameters were similar (Table). Kaplan-Meier analysis revealed a significantly better one-year clinical outcome in PB group than CP group (p=0.038) (Figure).

Conclusions

The RYUSEI study revealed a pre-stent lesion modification in addition to nitroprusside infusion using PB is useful to achieve better clinical course in STEMI patients.Post PCI Angiographic and OCT FindingsComparison of One-year Clinical Outcome