bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes in patients admitted with diabetic ketoacidosis and heart failure with preserved ejection fraction
Authors: Lukan A , Fatuyi M , Alagbo H , Nduka T , Otulana R , Patel N , Sahni A , Analili M , Illah C
Published: November 2023

Introduction

Diabetic ketoacidosis is a common diabetic emergency requiring admission to the intensive care unit , patient with DKA usually present with profound dehydration secondary to osmotic diuresis and one of the major hallmark of treatment is adequate hydration with normal saline, the aim of this study is to establish the possible outcomes that might occur if a patient who has a background history of Heart failure with preserved ejection fraction with DKA, there are studies establishing a relationship between DKA and heart failure with reduced ejection fraction but none has been done to establish possible outcomes in this patient population and this study aims to bridge that gap.

Methods

We analyzed the National Inpatient Sample (NIS) database from 2018 to 2020. The NIS was searched for hospitalization of adult patients with DKA with and without heart failure with preserved ejection fraction . the outcomes analyzed were in-hospital mortality, Cardiogenic shock, septic shock, acute kidney injury, total hospital charge and length of stay. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders.

Results

A total of 261,410 patients were admitted for DKA, 7.8% (20,280) had HFPEF and 92.2% (241,130) were without HFPEF, among those with HFPEF 50.9% were female and 49.1% were male while among those without HFPEF 44.5% were female and 55.5% were male, compared with those without HFPEF, patients with HFPEF had a statistically significant increase in in-hospital mortality (1.92% vs 0.65%, p<0.007,OR-1.46, 95% CI 1.10-1.93) Length of stay (5.3 vs 3.6, p value<0.0001, IRR = 1.12, 95% CI 1.08-1.15), septic shock (3.08% vs 1.49%, p value<0.023, OR = 1.27, 95% CI 1.03-1.56), cardiogenic shock (0.9% vs 0.19%, p value<0.0001, OR = 4.6, 95% CI 2.77-7.66) and Total hospital charge ($55583.7 vs $38632.24, p value<0.0001, IRR = 1.15, 95% CI 1.1-1.19), there was no statistically significant difference in acute kidney injury(53.21% vs 44.27% p value 0.09, OR 1.1, 95% CI 0.89-1.23)

Conclusion

This study has been able to establish a significant increase in in-hospital mortality, Length of stay, septic shock, cardiogenic shock and total hospital charge in patients with DKA and HFPEF and no difference in the rate of AKI, patients with HFEPF should be considered as a special population when managing DKA and fluid management in this patient population will need further studies.
Repetitive LevosimenDan infusions fOR patients with advanced chronic heart failure in the vulnerable post-discharge period: the multinational randomized LeoDOR trial
Authors: Polzl G , Altenberger J , Comin-Colet J , Delgado J , Fedele F , Garcia-Gonzales M J , Gustafsson F , Masip J , Papp Z , Stoerk S , Ulmer H , Vrtovec B , Wikstrom G , Zima E , Bauer A
Published: November 2023

Background

Studies of the repetitive use of intravenous levosimendan suggested a beneficial effect in patients with advanced heart failure (HF). It was the aim of the LeoDOR trial to test the efficacy and safety of intermittent levosimendan therapy in the vulnerable phase following a hospitalization for acute HF.

Methods

In this multicenter, double-blind, three-armed trial with an enrolment period from 3-2018 to 6-2021, patients with advanced HF were randomized 2:1 at the end of an index hospitalization for acute HF to intermittent levosimendan therapy or placebo for a period of 12 weeks. Levosimendan was administered according to center preference either as 6-hour infusion at a rate of 0.2 mcg/kg/min every 2 weeks, or as 24-hour infusion at a rate of 0.1 mcg/kg/min every 3 weeks. The primary efficacy assessment after 14 weeks was based on a global rank endpoint consisting of three hierarchical groups: Tier 1 = time to death or urgent heart transplantation or implantation of a ventricular assist device; Tier 2 = time to non-fatal HF requiring i.v. vasoactive therapy; Tier 3 = time-averaged proportional change in NTproBNP from baseline to week 14.

Results

Due to a forced interim interruption of the study as a result of the COVID-19 pandemic, the planned number of patients could not be recruited. The final modified intention-to-treat (mITT) analysis included 145 patients (93 in the combined levosimendan arm, 52 in the placebo arm). Patient characteristics were well balanced between treatment and placebo arms (mean age 69.3±9.7 vs 67.9±10.1, proportion of women 22.6% vs 21.2%, HF-hospitalizations in previous 12 months 1.9±1.4 vs. 1.7±1.1, NTproBNP at baseline 4740 ng/L (IQR 2235 – 9016) vs 5380 ng/L (IQR 2287 – 8204). There were no marked differences regarding HF medication and implanted devices.

Compared with placebo, intermittent levosimendan had no significant effect on the primary endpoint (mean rank score 71.8 for the levosimendan group vs 75.1 for the placebo group; p = 0.65). However, there was a strong signal towards a higher incidence of the individual clinical components of the primary endpoint (tier 1 plus tier 2) in the levosimendan group vs the placebo group both after 14 weeks (HR 2.94, 95%CI 1.13–7.70; p = 0.028) and 26 weeks (HR 1.65 95%CI 0.87 – 3.12; p = 0.123). The number of investigator-reported adverse events during and immediately after drug application was 12.4% in the levosimendan group vs 11.8% in the placebo group (p = 0.905).

Conclusion

Our findings do not support the use of intermittent levosimendan to improve post-hospitalization clinical stability in patients who were recently hospitalized with HF and reduced LVEF. Further studies are warranted to find the correct use of levosimendan in advanced heart failure patients.
Prognostic value of three iron deficiency definitions in patients with advanced heart failure
Authors: Papadopoulou C , Reinhold J , Gruner-Hegge N , Kydd A , Bhagra S , Parameshwar K J , Lewis C , Martinez L , Pettit S J
Published: November 2023

Background

Iron deficiency (ID) is a common co-morbidity in patients with chronic heart failure (HF) and is an independent predictor of adverse prognosis including quality of life and exercise capacity (1-3). Intravenous iron replacement improves outcomes in HF patients including exercise capacity, quality of life, rate of HF hospitalisation and possibly mortality (1-4). Different definitions of ID are used in clinical practice. European HF guidelines define ID as a serum ferritin concentration of < 100 ng/ml, or a serum ferritin of concentration of 100-299 ng/ml with a transferrin saturation (TSAT) < 20% (5) because this definition was used in most trials of iron replacement in HF (1-3). However, other criteria to diagnose ID have been proposed based on comparison to the gold standard of bone marrow biopsy including serum iron ≤ 13 µmol/L and TSAT < 20% (6). Serum ferritin concentrations to diagnose ID has been criticised because inflammation can lead to increased serum ferritin concentrations even in patients who would fulfil ID criteria based on alternative definitions (7).

Purpose

The prognostic value of ID in patients with advanced HF, assessed for heart transplantation, is currently not well established. This patient population is characterised by relatively young age, single-organ pathology and prognosis is largely determined by the severity of heart disease rather than co-morbidities. In this study we investigated the prognostic value of various ID definitions in this patient cohort.

Methods and Results

Consecutive patients assessed for heart transplantation at a single UK centre between January 2010 and May 2022 were included. ID was defined as 1) serum ferritin concentration of < 100 ng/ml, or 100-299 ng/ml with transferrin saturation < 20% (guideline definition), 2) serum iron concentration ≤ 13 µmol/L, or 3) transferrin saturation < 20%. The primary outcome measure was a composite of all-cause mortality, urgent heart transplantation or need for mechanical circulatory support. 801 patients were included, and the prevalence of ID was 39-55% depending on definition used. ID, defined by either serum iron or transferrin saturation, was an independent predictor of the primary outcome measure [HR 1.532 (95% CI 1.264 - 1.944) and HR 1.595 (95% CI 1.323 - 2.033), respectively], but the same association was not seen with the guideline definition of ID [HR 1.085 (95% CI 0.8827 - 1.333)]. These findings were robust in multivariable cox regression analysis. ID, by all definitions, was associated with lower six-minute walk distance, lower peak oxygen consumption, higher intra-cardiac filling pressures and lower cardiac output.

Conclusions

ID, when defined by serum iron concentration or transferrin saturation was associated with increased frequency of adverse clinical outcomes in patients with advanced HF. The same association was not seen with guideline definition of ID.
Clonal hematopoiesis has prognostic value in dilated cardiomyopathy independent of age and clone size
Authors: Sikking M , Stroeks S L V , Henkens M T H , Raafs A G , Cossin B , Van Deuren R , Steehouwer M , Riksen N P , Van Den Wijngaard A , Brunner H , Hoischen A , Verdonschot J A J , Heymans S R B
Published: November 2023

Background

Clonal hematopoiesis (CH) gives rise to mutated leukocyte clones, that may induce cardiovascular inflammation, and thereby impact the disease course in cardiovascular diseases such as atherosclerosis and ischemic heart failure. The term clonal hematopoiesis of indeterminate potential (CHIP) is used when the variant allele frequency (VAF; a marker for clone size) in blood is ≥2%. The impact of CH clones in non-ischemic dilated cardiomyopathy (DCM) remains largely undetermined. Moreover, the impact of small clone sizes (VAF <0.5%) remains unknown in cardiovascular diseases in general.

Objectives

To establish the prognostic impact of CH in DCM down to small CH clone sizes.

Methods

CH was determined using an ultrasensitive single-molecule Molecular Inversion Probe technique that allows detection of clones down to a VAF of 0.01%. Cardiac death and all-cause mortality were predicted using receiver operating characteristic curve-optimized VAF cut-off values.

Results

520 DCM patients were included. 109 patients (21%) had CH driver mutations, of which 45 had a VAF of ≥2% and 31 had a VAF of <0.5%. The median follow-up duration was 6.49 years [interquartile range 4.69 - 9.71]. DCM patients with CH had a higher risk of cardiac death (HR 2.33 using a VAF cut-off of 0.36%, 95% confidence interval 1.24 - 4.40) and all-cause mortality(HR 1.72 using a VAF cut-off of 0.06%, 95% confidence interval 1.10 - 2.69), independent of age, sex, left ventricle ejection fraction and New York Heart Association classification.

Conclusion

CH predicts cardiac death and all-cause mortality in DCM patients with an optimal threshold for clone size of 0.36% and 0.06%, respectively. Therefore, CH may be prognostically relevant independent of clone size in patients with DCM.Clonal hematopoiesis characteristicsClonal hematopoiesis prognosis
Diuretic use and outcomes in patients with HFrEF: Insights from the VICTORIA trial
Authors: Ezekowitz J A , Alemayehu W , Edelmann F , Ponikowski P , Lam C S P , O'connor C M , Butler J , Homering M , Corda S , Mcmullan C J , Westerhout C M , Voors A A , Mentz R J , Armstrong P
Published: November 2023

Background

In the Vericiguat Global Study in Subjects with Heart Failure with Reduced Ejection Fraction (VICTORIA) trial, vericiguat, compared with placebo, reduced the risk of cardiovascular death (CVD) and heart failure hospitalization (HFH) in patients enrolled shortly after a worsening heart failure (WHF) event. We examined the clinical outcomes and efficacy of vericiguat as it relates to the background use of loop diuretics in this population of patients with WHF.

Methods

We calculated the total daily loop diuretic dose equivalent to furosemide dosing at randomization and categorized these as <40, 40, and >40 mg total daily dose (TDD). The primary composite outcome of CVD or HFH and its components were evaluated as clinical outcomes and expressed as adjusted hazard ratios (adjHR) and 95% confidence intervals (95% CI). Post-randomization rates of change in TDD and safety were also examined.

Results

Of 4434 patients with diuretic dose information available at randomization, 647 (14.6%) were on <40 mg, 1633 (36.8%) were on 40 mg, and 2154 (48.6%) were on >40 mg TDD. Patient characteristics revealed those patients taking >40 mg TDD were more often in NYHA Class III/IV, diabetic, and had higher NT-proBNP, lower eGFR, less triple guideline-based HF therapy, and a higher MAGGIC risk score. The composite event rate of CVD or HFH per 100 patient years (pt-yrs) progressively increased with higher doses of diuretics: 29.8 per 100 pt-yrs for 40 mg TDD: adjHR 1.23 (95%CI 1.02-1.49); 48.1 per 100 pt-yrs for >40 mg TDD adjHR 1.50 (95%CI 1.25-1.81), relative to <40 mg TDD (22.5 per 100 pt-yrs). Results were similarly observed for the components of the composite endpoint (Figure). There was no significant interaction for the efficacy of vericiguat vs placebo for any outcome examined according to TDD at randomization (p-interaction >0.72, 0.57 and 0.64 for the primary endpoint, CVD and HFH). Diuretic dose changes post-randomization were assessed in 3684 eligible patients (followed for a median duration of 14.2 months). By treatment group, there were similar rates of up-titration (26.7 and 29.4 per 100 pt-yrs), down-titration (13.8 and 15.4 per 100 pt-yrs), and stopping of diuretic use (23.4 and 24.2 per 100 pt-yrs) observed for vericiguat and placebo groups, respectively.

Conclusions

The amount of loop diuretic TDD at randomization was associated with a higher risk phenotype commensurate with worse outcomes. However, the efficacy of vericiguat was preserved across this range of different loop diuretic doses used by patients with recent WHF in VICTORIA.
Effect of eplerenone according to duration of heart failure in EMPHASIS-HF: It is never too late to start an MRA in HFrEF
Authors: Matsumoto S , Kondo T , Jhund P S , Swedberg K , Veldhuisen D J , Vincent J , Pocock S J , Pitt B , Zannad F , Mcmurray J J V
Published: November 2023

Background

In the Eplerenone in Mild Patients Hospitalization and Survival Study in Heart Failure trial (EMPHASIS-HF), the mineralocorticoid receptor antagonist (MRA) eplerenone reduced both the risk of death and heart failure (HF) hospitalization in patients with HF and reduced ejection fraction (HFrEF) and mild symptoms. However, many patients are still not prescribed an MRA and physicians may be reluctant to add another treatment in patients with longstanding HF who appear to be "stable" on their current therapy.

Purpose

As little is known about how the effect of MRA therapy varies by the duration of HF, we examined the efficacy of eplerenone according to time from HF diagnosis among patients in EMPHASIS-HF. The primary trial outcome was the composite of a first hospitalization for HF or cardiovascular death.

Methods

Three patient groups of similar size were created according to the duration of HF: <1 year, ≥1 to <5 years, and ≥5 years. Outcomes were analysed using Cox regression and the Kaplan-Meier estimate. Treatment effects were examined according to HF duration category and also using the duration of HF as a continuous variable.

Results

The number of patients in each group was: 975 (<1 year), 769 (1 - <5 years), and 988 (≥5 years), respectively. Patients with longer duration of HF were older and more frequently had an ischaemic aetiology of HF. Additionally, a longer duration of HF was associated with lower eGFR levels, wider QRS duration, and a higher proportion of atrial fibrillation at baseline. The rate of the primary outcome (per 100 person-year) increased with HF duration: 9.8 (95% CI: 8.4-11.4) for <1 year, 13.5 (11.6-15.7) for 1 - <5 years, and 17.6 (15.6-19.8) for ≥5 years. Similar trends were seen in all other outcomes (Figure 1). The hazard ratios for the effect of eplerenone compared to placebo on the primary outcome were 0.57 (95% CI: 0.42-0.79) for <1 year, 0.81 (0.60-1.10) for 1- <5 years, and 0.61 (0.48-0.78) for ≥5 years; P for interaction = 0.24. The benefits of eplerenone were also consistent across the duration of HF examined as a continuous variable (Figure 2). For the primary outcome, The number needed to treat (NNT) over the duration of the trial, for the primary outcome, was 14 for <1 year, 13 for 1 - <5 years and only 10 for ≥5 years duration.

Conclusions

Patients with a longer duration of HF had worse clinical status and a higher rate of events, but the benefit of eplerenone was consistent in people with longer-standing HF and HF of shorter duration. These data suggest that it is never too late to start an MRA in patients with HFrEF.

Figure 1. Outcomes according to heart failure duration category

Abbreviations: CV cardiovascular; HF heart failure

Figure 2. Treatment effects according to the duration of heart failure

Abbreviations: CV cardiovascular; HF heart failureFigure 1Figure 2
Mitochondrial function is abnormal in circulating blood monocytes of patients with chronic heart failure
Authors: Sabbah H , Gupta R C , Singh-Gupta V , Castle K , Lanfear D E
Published: November 2023

Background

Cardiac mitochondrial function is abnormal in heart failure (HF) and is likely to contribute to disease progression. We previously showed that in dogs with HF mitochondrial functional abnormalities exist in both failing cardiomyocytes and in circulating blood monocytes, and to similar extent. This finding suggested the possibility that mitochondrial function in circulating monocytes can serve as a surrogate for cardiac mitochondrial function. We also showed that mitochondrial abnormalities exist in cardiomyocytes of patients with chronic HF.

Purpose

In the present study we sought to test the difference between patients with advanced HF and age-matched controls in terms of circulating monocyte mitochondrial function.

Methods

We examined circulating blood monocytes from 10 patients evaluated in our advanced HF clinic and with left ventricular ejection fraction <35%. compared to 10 age-matched control persons without cardiac disease (CON). Peripheral blood samples (15 ml) were obtained from each participant and monocytes were isolated using standard Ficoll-Paque gradient centrifugation. Isolated monocytes were suspended in Agilent XF-DMEM base buffer for quantification of mitochondrial function with Seahorse XFe96 analyzer. The following key mitochondrial functional parameters were determined: basal respiration (BASEresp), ATP production-linked respiration (ATPresp), maximal respiration (MAXresp) and respiratory capacity (RC).

Results

BASEresp, ATPresp, MAXresp and RC were significantly lower in monocytes of patients with HF compared to NL subjects (BASEresp 2.7 ± 0.7 vs. 5.2 ± 1.6, p<0.05; ATPresp 10.0 ± 0.8 vs. 15.9 ± 1.0, p<0.05; MAXresp 36.5 ± 5.9 vs. 69.3 ± 3.8, p<0.05; RC 26.5 ± 5.5 vs. 53.5 ± 3.5, p<0.05).

Conclusions

Mitochondrial dysfunction is present in circulating blood monocytes of patients with chronic HF. These findings coupled to those in dogs with HF suggest the possibility that determination of mitochondrial function in peripheral monocytes may identify those patients with HF with cardiac energetic deficiencies. If validated this technique could help illuminate how cardiac energy deprivation relates to disease progression and potentially enable targeted therapies directed at mitochondria dysfunction.
Relationship between the right ventricular function and MECKI score in patients with advanced heart failure
Authors: Acar R D , Halil G S , Deger S , Akbal O Y , Dogan C , Efe S C , Kirali K
Published: November 2023

Background

Three- dimensional echocardiography (3DE) is an attractive technique for assessment of RV wrapping around the conical left ventricle and MECKI score is a strong predictor of prognosis in patients with advanced heart failure.

Purpose

We aimed to evaluate the relationship between the right ventricular function obtained by 3DE and MECKI Score in patients with advanced heart failure.

Methods

The Metabolic Exercise test data combined with Cardiac and Kidney Indexes (MECKI) score was calculated by an online free calculator using parameters peak oxygen uptake (% predicted value) and VE/CO2 slope values obtained by CPET, blood samples such as hemoglobin, sodium, MDRD and left ventricular ejection fraction (LVEF).(1)

Results

The 43 patients with sinus rhythm who were candidates for heart transplantation or left ventricular assist device (LVAD) therapy between June 2022 and January 2023 were included in the study. The majority of the patients were male (% 81). The mean 3D LV EF was % 22 ± 3.8, the mean value for peak VO2 max obtained by CPET was 15 ± 5.8 ml/kg/min and the median value for VE/CO2 slope was 34 (24-99). When the right ventricular parameters were compared according to the median value of 34, the right ventricle was larger and parameters of the right ventricular systolic function were worse in patients with the higher VE/CO2 slope values. (Figure 1). The mean value for percentage of predicted peak VO2 max was % 52 ± 16 and the median for the MECKI Score was 9.3 (1.8-86). By univariate and multivariate regression analyses, only the 3D RV basal diameter was found independently associated with peak VO2 max. Also, the VECO2 slope was found independently associated only with 3D RV TAPSE. Also these two parameters, 3D RV basal diameter and 3D RV TAPSE were found independent predictors of MECKI score. In ROC analysis, the cut off value 40.9 mm for 3D RV basal diameter to predict MECKI score with sensitivity and specificity were % 90 and % 68 , respectively (AUC:0.792). Also, AUC was 0.784 for the cut off value of 7.7 mm for 3D RV TAPSE with the sensitivity % 90 and specificity % 81. (Figure 2).

Conclusion

The major findings in this study were RV basal diameter was an independent predictor of the peak VO2 max value and RV 3D TAPSE was an independent predictor of the VECO2 slope. These results suggest that, while the basal diameter of the right ventricle, in other words, the size of the right ventricle effects peak oxygen consumption, the O2 transport and utilization, 3D TAPSE, namely systolic function of the right ventricle effects the ability to remove C02 from the whole body. Also these two parameters were found independent predictors of the MECKI score which is a strong predictor of prognosis in patients with advanced heart failure.Figure 1Figure 2
Prognostic impact of lung ultrasound detected B-Line on hospitalized ischemic HFmrEF patients
Authors: Zhu Y L , Zhang H , Zhou Y Y , Chen F Q , Li N , Peng X , Wu M X , Huang H B , Zhang L L , Liao M , Xiao S H A , Chen Y L , Chen S H , Liu Z C , Zeng J P
Published: November 2023

Background

The prognostic impact of lung ultrasound derived B-Line (LU-BL) in heart failure patients with mildly reduced left ventricular ejection fraction (HFmrEF) remains elusive. We evaluated the correlation between LU-BL and prognosis in HFmrEF patients.

Methods

This study screened consecutive hospitalized HFmrEF patients in our hospital between January 2015 and August 2020 with LU-BL results at admission. LU-BL results at admission were available in 610 HFmrEF patients, and majority patients were diagnosed as ischemic HFmrEF (574, 94.1%). We thus observed the prognostic impact of LU-BL on ischemic HFmrEF patients. Patients completed at least one year of clinical follow-up through telephone, clinical or community visits after discharge. The primary endpoint was defined as the composite endpoint of cardiovascular (CV) death or heart failure hospitalization (CV event) at 90 days and 1-year post discharge.

Results

CV event at 90 days were significantly higher with higher LU-BL number (0; 1-2; 3-9; ≥10: 12.8%, 11.9%, 14.3% and 28.9%, P<0.001). Kaplan-Meier curves showed LU-BL >6 was associated with increased CV event at 90 days (Log rank P<0.001) and at 1 year (Log rank P = 0.029). After adjusted for clinical and echocardiographic covariates, multivariable Cox regression analysis showed that LU-BL>6 (HR 1.036, 95% CI 1.011-1.062, P = 0.005) and LU-BL >11 (HR 1.882, 95% CI 1.225-2.891, P = 0.004) were independently associated with increased CV event rate at 90 days. The lowest CV event rate at 90 days post discharge was identified in patients with LU-BL<11 and free of diabetes (10.4%). Presence of diabetes was associated with 2-fold higher CV event rate at 90 days post discharge in ischemic HFmrEF patients with LU-BL ≤11 (20.3%).

Conclusions

LU-BL>6 and 11 is independently related worse cardiovascular outcome at 90 days post discharge in ischemic HFmrEF patients. Diabetes is a fundamental risk factor of worse cardiovascular outcome within 90 days post discharge in ischemic HFmrEF patients with LU-BL<11.LU-BL and outcome of ischemic HFmrEF
The prognostic association of atrial fibrillation on heart failure hospitalizations after acute myocardial infarction
Authors: Yandrapalli S , Achanta A , Malik A H , Aronow W S , Zaman S , Januzzi J L , Wasfy J H
Published: November 2023

Aims

The association of atrial fibrillation (AF) with heart failure (HF) specific hospitalizations after acute myocardial infarction (AMI) is unclear. We aim to study the association of AF and 6-month HF hospitalization after an AMI in a large American cohort.

Methods and Results

Adult survivors of a AMI hospitalization without cardiogenic shock were identified from the 2019 US Nationwide Readmissions Database. The unadjusted association of AF (pre-existing and denovo) with baseline characteristics and primary outcome of rate of 6-month HF admission, and secondary outcomes of fatal HF admission, composite of HF peri-AMI or a 6-month HF admission, and a composite of 6-month HF or death during a non−HF-related admission was evaluated using chi square tests or t-tests, and independent associations of AF on outcomes were evaluated using multivariable logistic regression. Cox proportional hazards models were used to identify the association of AF on cumulative incidence risk on HF readmission.

Of 262,390 AMI survivors, AF was present in 18.0%. By 6-months, HF hospitalization occurred in 5.4% of all patients. AF was associated with a higher adjusted risk for 6-month HF admission (OR 1.42, 95% CI: 1.34-1.50). In the adjusted time-to-event analysis, AF was associated with a higher risk for 6-month HF readmission (HR 1.39, 95% CI 1.31-1.46, P<0.001). AF was associated with a higher risk for fatal HF and the composite outcomes.

Conclusions

AF was present in 1 in 6 AMI survivors without cardiogenic shock and AF was associated with a higher risk of HF hospitalization in the subsequent 6-month period.Cumulative Incidence CurvesOutcomes Table
Echocardiography-based risk score predicts cardiovascular outcomes in ischemic heart failure patients with reduced ejection fraction
Authors: Liu D , Hu K , Wagner C , Kreipl M , Sokalski V , Lau K , Lengenfelder B , Ertl G , Frantz S , Nordbeck P
Published: November 2023

Background

Ischemic heart disease (IHD) is the most common cause of heart failure (HF) and serves as an important prognostic factor across the whole HF spectrum. Prognostic assessment is important for optimal patient care, and a number of prediction models or prognostic scores have been developed in the past years for risk stratification of HF patients.

Purpose

Present study aimed to develop a comprehensive echocardiography-based score algorism for risk assessment of ischemic heart failure (IHF) patients with reduced left ventricular ejection fraction (<50%).

Methods

This study included 1355 IHF patients with ejection fraction <50%, the median clinical follow-up was 25 months. Multivariable Cox hazard models were used to assess the associations between echocardiography variables [including 13 standard parameters and global longitudinal strain (GLS)] and major adverse outcomes [including all-cause mortality, cardiovascular (CV) death, and CV related hospitalization].

Results

Rates of all-cause mortality, CV mortality, and combined CV events including death and hospitalization, were 29.2%, 18.2%, 41.1%, respectively. Right ventricular mid-cavity diameter (RVD)>38mm, mitral annular plane systolic excursion (MAPSE)<8mm, tricuspid annular plane systolic excursion (TAPSE)<12mm, transmitral early flow velocity to mitral annular velocity ratio (E/E´)>14.5, systolic pulmonary artery pressure (sPAP)>38mmHg, and absolute GLS<8% were identified as independent echocardiographic indexes for worse clinical outcome in the multivariable Cox models. An echocardiography-based risk score (Echo Risk Score, ranged from 0 to 6 points) was established based on these markers and patients were classified into 3 risk groups: a score of 0 to 1 as low-risk, 2 to 3 as intermediate-risk, and 4-6 as high-risk. After adjustment for all clinical covariates, high-risk patients faced 2 to 3-fold increased risk of all-cause mortality (HR 2.42, 95% CI 1.81-3.24), CV mortality (HR 2.75, 95% CI 1.88-4.02), and combined CV events (HR 1.84, 95% CI 1.43-2.36) compared with low-risk patients. Incremental predicting efficacy was evidenced after the addition of Echo Risk Score either to the model including clinical risk factors or to the model including clinical risk factors and N-terminal prohormone of brain natriuretic peptide (all P<0.001, Figure 1).

Conclusions

This new echocardiography-based risk score is significantly and independently associated with all-cause mortality and CV mortality or hospitalization in ischemic heart failure patients with reduced ejection fraction. Future studies are warranted to validate the predicting efficacy of this echocardiography-based risk score in ischemic heart failure patients with reduced ejection fraction.Figure 1
Association between liver stiffness and congestive heart failure; analysis of the NHANES 2017 - 2020
Authors: Wattanachayakul P , Rujirachun P , Phichitnitikorn P , Lopimpisuth C , Lalitnithi P , Tantisattamo E
Published: November 2023

Background

Recent studies have shown that liver stiffness is associated with increased cardiovascular events, whether the association between liver stiffness stratified by fibrotic stages and congestive heart failure (CHF) remains unclear.

Methods

We examined a cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 that included participants ≥18 years old. The association between the degree of liver stiffness classified into four fibrosis scores measured by Fibroscan™ and history of CHF informed by a doctor or other health professional was examined by multiple logistic regression.

Results

We identified 9,700 patients with Fibroscan™

results

The mean ± SD age was 44+/-20 years old, and 49.9% were female. White accounts for 33.7%, followed by Black (26.3%), Mexican American (12.5%), Asian (11.7%), Hispanic (10.1%), and others (5.6%). Among patients with Fibroscan™ results, up to 227 participants (2.8%) had congestive heart failure. Participants were classified into four fibrotic stages, including mild (F0F1), moderate (F2), severe fibrosis (F3), and cirrhosis (F4) of 8,194 (84.5%), 873 (9.0%), 304 (3.1%), and 329 (3.4%), respectively. The risk of CHF among individuals with severe fibrosis (F3) and cirrhosis (F4) was significantly higher compared to individuals with mild fibrosis (F0F1) with the OR of 3.22 and 4.46, respectively (F3: 95%CI 1.99, 5.22, P <0.0001, F4 95%CI 2.97, 6.72, P <0.0001); while the risk of CHF among patient with moderate fibrosis (F2) was 1.20 times as likely to have CHF compared to mild fibrosis(F0F1) but not statistically significant (F2: 95%CI 0.76, 1.90, P 0.411). After adjusting for age, gender, race, BMI, smoking status, high systolic blood pressure (<130 vs.>130 mmHg), and diabetic status, only participants with cirrhosis (F4) were 1.86 times as likely to have CHF compared to those with mild fibrosis (F0F1) (95%CI 1.13, 3.05, P 0.014); However, among participants with moderate(F2) and severe fibrosis(F3), the risk of CHF was 0.77 and 1.34 times respectively but not statistically significant (F2: 95%CI 0.46, 1.26, P 0.304; F3: 0.76, 2.33, P 0.302).

Conclusion

Liver stiffness was positively associated with the likelihood of having CHF. Additional longitudinal studies are required to further evaluate this relationship.
Echocardiographic characterization of patients with supranormal ejection fraction: pooled core laboratory analysis of the TOPCAT and PARAGON-HF trials
Authors: Wang X , Chatur S , Lu H , Claggett B , Skali H , Vaduganathan M , Minamisawa M , Inciardi R M , Shah A M , Packer M , Pitt B , Rouleau J , Pfeffer M A , Mcmurray J J V , Solomon S D
Published: November 2023

Background

Patients with heart failure and supranormal ejection fraction (HFsnEF) may be phenotypically distinct from those with normal or below normal left ventricular ejection fraction (LVEF), and may demonstrate different prognostic trajectories or treatment responses.

Purpose

To characterize clinical features, cardiac structure and function among patients with HF with preserved EF (defined as 45% ≤ LVEF ≤ 65%) and supranormal EF (defined as LVEF>65%).

Methods

Baseline clinical characteristics and key echocardiographic parameters from patients enrolled in the echocardiographic substudies of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist)-Americas and PARAGON-HF (Prospective Comparison of ARNI [angiotensin receptor–neprilysin inhibitor] with ARB [angiotensin-receptor blocker] Global Outcomes in Heart Failure with Preserved Ejection Fraction) were compared between patients with and without HFsnEF.

Results

Among 1,751 participants (mean age 73 years old, 51% women) in this pooled core laboratory analysis, 265 (15%) had HFsnEF. Participants in HFsnEF group were more likely to be women, and less likely to have prior myocardial infarction and atrial fibrillation (Table 1). Compared with those with LVEF ≤ 65%, those with LVEF > 65% had lower LV end-diastolic and end-systolic volume indices, lower LV mass index, higher LV relative wall thickness, and higher right ventricular fractional area change. LV geometry and measures of LV diastolic function were similar in both groups (Table 1). Global longitudinal strain (GLS) was abnormal (absolute GLS <16%) in 28% in those with HFsnEF compared with 53% in those with LVEF ≤ 65%. After adjusting for baseline LV ejection fraction and sex, and stratified by trial, abnormal GLS was associated with a higher risk of composite of first heart failure hospitalization or cardiovascular death (overall hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.23 – 1.98, P < 0.001), cardiovascular death (overall HR 2.06, 95% CI 1.35 – 3.13, P = 0.001), and heart failure hospitalization (overall HR 1.49, 95% CI 1.15 – 1.93, P = 0.003) in both HFsnEF and non-HFsnEF groups (P-interaction > 0.05 for all, Figure 1).

Conclusions

Among participants in the TOPCAT-Americas and PARAGON-HF trials, those with LVEF > 65% were predominantly women, had less LV remodeling, and had better RV function based on echocardiographic measures. Nevertheless, despite supranormal LVEF, GLS was abnormal in over a quarter of patients and remained an important predictor of adverse clinical outcomes in this cohort.Table 1Figure 1
Outcomes of asymptomatic left ventricular dysfunction in the patient with or without type 2 diabetic Mellitus
Authors: Ling L , Sung S H
Published: November 2023

Background

Type 2 diabetes mellitus (T2DM) has been related to ventricular systolic and diastolic dysfunction and subsequent heart failure. [1] The study aimed to investigate the prevalence of asymptomatic left ventricular dysfunction (aLVD) in subjects with T2DM, and its predisposing factors.

Method

Subjects without existed cardiovascular disease were eligible for this study. Left ventricular ejection fraction (LVEF), mitral E/A ratio, peak mitral annulus tissue velocity (e’), left atrial dimension (LAD), peak tricuspid regurgitation velocity (TR Vmax) were obtained by a standard echocardiographic study. Asymptomatic left ventricular diastolic dysfunction (ALVSD) was defined as LVEF < 50% and the asymptomatic left ventricular diastolic dysfunction (ALVDD) was defined as having three or more of the four parameters: septal e' < 7, septal E/e’>15, LAD > 40mm, and TR Vmax > 2.8 m/s. [2] All-cause mortality up to 2 years was obtained by linking to the National Death Registry.

Result

A total of 27684 subjects (59.6±17.4 years, 46.2% men, 17.7% diabetes) were included in this study(Table 1). The ALVSD patients were older, male dominant, more prevalent with hypertension, diabetes mellitus and coronary artery disease, and had higher BMI, lower hemoglobin, and estimated glomerular filtration rate. ALVSD and ALVDD was more prevalent in patients with T2DM than those without (4.9% vs 8.2%, P<0.001)(15.4% v.s. 32.1%) (Figure 1). Age (odds ratio and 95% confidence interval: 1.04, 1.03–1.04), male gender(2.24, 1.99-2.52), T2DM (1.28, 1.11-1.46), coronary artery disease (1.38, 1.14-1.68), hemoglobin (0.95, 0.91-1.00), CKD stage 3(2.02, 1.63-2.50), and CKD stage 4-5(3.95, 3.06-5.09) were all independently correlated to ALVSD(Table 2a). On the other hand age (odds ratio and 95% confidence interval: 1.07, 1.07–1.08), BMI (1.12, 1.11-1.13), T2DM (1.34, 1.24-1.46), hypertension (1.31, 1.20-1.43), hemoglobin (0.88, 0.85-0.91), and CKD stage 4-5(3.11, 2.58-3.76) were independently correlated to ALVDD(Table 2b). During a mean follow-up of 5.3 ± 3.6 years, there were 2625 deaths (9.5%). The Kaplan–Meier curve analysis revealed diabetic subjects with were associated with the worst survival rate than those with either T2DM or ALVSD/ALVDD (Figure 2). The Cox regression analysis revealed the ALVDD and ALVSD was related to mortality, independent of age, gender, body mass index, hypertension, coronary artery disease, hemoglobulin, estimated glomerular filtration rate, and medication [hazard ratio and 95% confidence interval of mortality(ALVSD/ALVDD): 1.78 (1.40–2.25)/1.31(1.15-1.49)].

Conclusion

ALVD has a high disease burden in patients without established cardiovascular disease, and its prevalence is higher in patients with T2DM, which was associated with an excessive mortality rate. Therefore, early screening and intervention should be considered in diabetic patients.
Prognostic impact of a novel risk score for transcatheter edge-to-edge repair in patients with heart failure: sub-analysis of FRAGILE-HF
Authors: Kaneko T , Kagiyama N , Kasai T , Kamiya K , Saito H , Saito K , Maekawa E , Konishi M , Kitai T , Iwata K , Jujo K , Wada H , Momomura S , Matsue Y , Minamino T
Published: November 2023

Background

MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients.

Methods

We calculated MitraScore for 1100 elderly patients (>65 years old) hospitalized for HF in the prospective multicenter FRAGILE-HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all-cause deaths, and the secondary endpoints were the composite of all-cause deaths and HF rehospitalization and cardiovascular deaths.

Results

During a follow-up of two years, 226 all-cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in Kaplan-Meier analysis (p<0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments (adjusted hazard ratio (HR) [95% confidence interval]: 1.22 [1.10-1.36], p<0.001 for all-cause deaths; adjusted HR 1.17 [1.09-1.26], p<0.001 for combined endpoints; and adjusted HR 1.24 [1.10-1.39], p<0.001 for cardiovascular deaths). Hosmer-Lemeshow plot showed good calibration for all endpoints (p = 0.86-0.99). MitraScore resulted in significant reclassification improvements in all-cause and cardiovascular deaths as compared with the GWTG-HF risk score, BIOSTAT compact model, AHEAD and AHEAD-U scores, and HANBAH score.

Conclusion

MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. These results might suggest that HF patients and those receiving TEER shared similar prognostic factors.Kaplan–Meier curves for all-cause deathComparison with other scores
Associations of fasting state glycemic biomarkers with mortality and morbidity in heart failure: Retrospective cohort study
Authors: Iwasaki K , Akagi S , Nakamura K , Ito H
Published: November 2023

Background

Diabetes mellitus (DM) is a common comorbidity among heart failure (HF), complicated with 10% to 47% of HF patients. DM is also known to be associated with cardiovascular mortality and hospitalization for heart failure (HHF) in HFpEF and HFrEF. Though HbA1c is the most used glycemic control target, whether HbA1c is the most appropriate glycemic control marker remains to be investigated.

Purpose

To evaluate relationships between clinical outcomes and glycemic markers among heart failure patients, including HbA1c, HOMA-β and HOMA-IR.

Methods

We retrospectively evaluated the relationships between fasting state glycemic markers, including HbA1c, HOMA-β and HOMA-IR, and clinical outcomes in heart failure patients admitted to our hospital from 2016 to 2020. These glycemic markers were calculated from fasting blood glucose and insulin concentrations. The primary outcome was composite of all cause death or HHF. Multivariate Cox regression proportional hazards models were used to assess the relationship between glycemic markers and clinical outcomes, adjusting for age, sex, DM, BMI, ischemic etiology, eGFR, log-transformed BNP and urgent hospitalization.

Results

682 patients were included in the analyses. Median age was 70 years (IQR 59 to 77 years), and 66% were male. 41% patients had left ventricular ejection fraction below 40%, and 32% had DM. The median follow-up periods were 16.5 months (IQR 4.4 to 37.3 months). HOMA-IR was independently associated with the primary outcome (HOMA-IR 1.0 to 2.5: HR1.34, 95%CI 0.79 to 2.28, p = 0.27; HOMA-IR 2.5 to 10: HR2.19, 95%CI 1.30 to 3.66, p = 0.003; HOMA-IR >10: HR2.92, 95%CI 1.61 to 5.30, p<0.001), but HbA1c and HOMA-β were not associated with the primary outcome (HbA1c 6.0 to 7.0: HR0.99, 95%CI 0.70 to 1.38, p = 0.94; HbA1c 7.0 to 8.0: HR0.80, 95%CI 0.48 to 1.34, p = 0.39; HbA1c >8.0: HR1.02, 95%CI 0.48 to 2.20, p = 0.95; HOMA-β <30: HR0.98, 95%CI 0.64 to 1.51, p = 0.94) (figure 1). Receiver-operator characteristics curve analysis revealed that HOMA-IR (AUC 0.60, 95%CI 0.55 to 0.65) had a significantly better predictive value for the primary outcome compared with HbA1c (AUC 0.56, 95%CI 0.51 to 0.61) and HOMA-β (AUC 0.51, 95%CI 0.46 to 0.56) (Figure 2).

Conclusion

Among fasting state glycemic biomarkers, HOMA-IR was independently associated with mortality and morbidity in HF, but HbA1c and HOMA-β were not. HOMA-IR may aid better DM managements among HF patients beyond current HbA1c targeted DM managements.Adjusted hazard ratio of glycemic markerROC analysis for the primary outcome
Impact of different types of heart failure on coronavirus disease 2019 infection outcomes
Authors: Al-Taweel O , Gill A , Shao R , Wineinger T , Alkhatib D , Ahsan C
Published: November 2023

Background

Pre-existing cardiovascular disease has been associated with increased mortality in patients with coronavirus disease 2019 (COVID-19). However, the impact of different types of heart failure in unvaccinated patients with COVID-19 infection has been understudied.

Purpose

In this study, we compare the in-hospital outcomes of patients with COVID-19 and chronic heart failure with reduced ejection fraction (HFrEF) against patients with COVID-19 and chronic heart failure with preserved ejection fraction (HFpEF).

Methods

This was a retrospective cohort study done by utilizing the 2020 National Inpatient Sample database. We identified patients admitted to the hospital with a principal diagnosis of COVID-19 infection and a secondary diagnosis of either chronic HFrEF or HFpEF. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression, adjusted for age, sex, hospital characteristics (bed size, location, region), health insurance and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, hypertension, obesity, prior myocardial infarction and type 2 diabetes mellitus. The categorical and continuous variables were analyzed by Pearson’s chi-squared and Student t-test respectively.

Results

12,518 patients met our inclusion criteria. Patients with COVID-19 infection and chronic HFrEF had 1.11 times higher odds of suffering in-hospital mortality compared to patients with COVID-19 infection and chronic HFpEF (aOR 1.11, 95% CI: 1.01-1.21; p = 0.03). When separated by race, there was no difference in mortality between our two cohorts (Figure 1). Patients with COVID-19 infection and chronic HFrEF were more likely to have acute hepatic failure (1.2% vs 0.6%, p < 0.001), ventricular tachycardia (6.7% vs 3.1%, p < 0.001) and ventricular fibrillation (0.6% vs 0.2%, p < 0.001), but less likely to have acute respiratory distress syndrome (5.0% vs 6.6%, p < 0.001, Table 1). In terms of comorbidities, patients with both COVID-19 and chronic HFrEF were more likely to have atrial fibrillation (22.8% vs 21.3%, p = 0.03) coronary artery disease (39.5% vs 35.1%, p < 0.001) and prior myocardial infarction (8.8% vs 6.4%, p < 0.001, Table 1). These patients also had shorter hospital stays (8.4 days vs 9.0 days, p < 0.001), but there was no difference in mean total hospital charges ($87,975.84 vs $88,715.96, p = 0.75, Table 1).

Conclusion

Patients with COVID-19 and chronic HFrEF had higher odds of suffering in-hospital mortality compared to patients with COVID-19 and chronic HFpEF. These patients were also more likely to have acute hepatic failure, ventricular tachycardia and ventricular fibrillation. Further studies should investigate how COVID-19 vaccination status influences the outcomes of this vulnerable population.