bluuebunny/crossref_metadata_2025 huggingface dataset:
Normal reference of myocardial work during exercise stress echocardiography and the doubt about wasted work
Authors: Wang Y , Yin L
Published: October 2024

Aims

Myocardial work (MW) estimated based on pressure-strain loops is a noninvasive parameter for evaluating left ventricular function. The aims of this study were (1) to characterize the MW changes at rest and post-exercise in healthy adults and heart failure with preserved ejection fraction (HFpEF) patients, (2) to explore the related influencing factors for the increase of global wasted work (GWW) after exercise.

Methods and results

The study enrolled 167 healthy adults and 38 HFpEF patients. All subjects underwent comprehensive echocardiographic assessment at rest and immediately after a symptom-limited treadmill stress test. The MW changes and the impact of sex were analyzed. The related influencing factors for the increase of GWW after exercise were explored. Global work efficiency (GWE) was decreased and other global parameters were increased after exercise in normal adults. There was no significant difference of all global parameters between sexes at rest. GWE was higher in men after exercise (p<0.05).There was no significant difference in MW reserve parameters between sexes. Peak positive strain (PPS) significantly increased after exercise, while GWE reduced in normal adults and HFpEF patients (p<0.05). PPS was independently associated with GWW in normal adults and patients with HFpEF both at rest and after exercise (normal adults: r: 0.77, p<0.001 at rest, r: 0.72, p<0.001 after exercise; HFpEF patients: r: 0.74, p<0.001 at rest, r: 0.62, p<0.001 after exercise).

Conclusion

Global MW parameters were less affected by sex. PPS was independently associated with GWW in normal adults and patients with HFpEF and the work done due to myocardial elongation might not be calculated as wasted work during the isovolumic contraction phase.example of myocardial work and PPSThe relationship between PPS and GWW
High altitude exercise stress echocardiograph for identification of susceptibility to acute mountain sickness
Authors: Wang Y , Xu Y , Wang S J , Yin L X
Published: October 2024

Background

Acute high-altitude exposure increases the risk of acute mountain disease (AMS) and high-altitude pulmonary edema. After the initial exposure to high altitude, mountain climbers are worried about whether they will develop AMS. At high altitudes, there are no accurate indicators to predict the near future occurrence of AMS.

Objectives

To investigate whether treadmill exercise stress echocardiography at high altitude can predict the occurrence of AMS, and to find out some powerful factors associated with the susceptibility to AMS.

Methods

36 healthy lowlanders were taken by bus from sea level to an altitude of 3600 m the next morning, during which they rested overnight at an altitude of 2150 m. Treadmill exercise stress echocardiography was performed immediately upon arrival at 2150 m, and the 2018 Lake Louise Questionnaire Score was performed the next day when arrived at the altitude of 3600 m. Heart rate (HR) and blood pressure (BP) were monitored during stress echocardiography. Left ventricular (LV) ejection fraction and E/e’ were calculated at rest and immediately after exercise. Other right ventricular systolic function parameters and pulmonary artery pressure (PAP) were calculated at the same time, which included tricuspid regurgitation velocity (TRV), tricuspid annular peak systolic excursion (TAPSE), systolic PAP (SPAP), right ventricular (RV) dimension by 2D, RV fraction of area change (FAC), right ventricular outflow tract velocity time integral (RVOT VTI). Pulmonary vascular resistance (PVR) was calculated according to the formula: TRV/RVOT VTI*10+0.16. Mean PAP (mPAP) was calculated as the formula: sPAP*0.61+2. All subjects ascended to 3600m within 24 hours by bus. AMS was identified by 2018 Lake Louise Questionnaire Score. Univariable and multivariable logistic regression analysis assessed independent factors associated with AMS.

Results

At the altitude of 3600m, 13 of 36 subjects had AMS, which defined as AMS (+) group. And the rest was AMS (-) group. There were no significant differences in HR, BP, SO2 and LV systolic and diastolic function between the two groups (P > 0.05). No significant differences were noted at rest except for TV s' (P < 0.05). Immediately after exercise, TRV, TAPSE, SPAP, mPAP, PVR, and RV area at the end of systole were much higher in AMS (+) group (all P < 0.05). While FAC and TVs’/SPAP were much lower in AMS (+) group (P < 0.05). By multivariable logistic regression model, mPAP immediately after exercise was significantly correlated with AMS occurrence (OR =1.332, 95% CI: 0.669-0.993, P= 003). The cutoff value of mPAP to predict AMS was 32 mmHg (AUC: 0.831, specificity: 86.7%, sensitivity: 76.9%).

Conclusions

The mPAP immediately after exercise upon arrival at an altitude of 2150 m is a strong predictor of near future AMS, and treadmill exercise stress echocardiography is a simple and non-invasive tool to help mountain climbers avoid more severe mountain sickness.
Regadenoson stress echocardiography: a road ahead
Authors: Fernandez Galindo M , Capdeville S , Abad Romero R , Nieto Becerro S , Denche C , Garcia Robles J A , Arribas Ynsaurriaga F , Solis J
Published: October 2024

Introduction

Drugs used in stress echocardiography (SE) have important limitations due to side effects and contraindications. Since its approval in 2008, Regadenoson has seen a significant increase in usage. This is largely attributed to its good safety profile and diagnostic accuracy, making it the preferred drug for stress tests in many European centers. However, despite its expanding use and major advantages, current guidelines don't place it as the first choice for SE, probably because the reported experience with this drug remains limited. The aim of the present study was to assess the safety and short-medium term prognosis of patients who underwent Regadenoson SE.

Methods

Retrospective observational study. Patients who underwent Regadenoson SE between 2017 and 2023 were included. Safety was assessed by monitoring immediate adverse effects following Regadenoson infusion and the need for using an antidote (Aminophylline). A positive test result was defined by the occurrence of any of the following: wall motion abnormalities, left ventricle dilatation, electrocardiographic changes or symptoms of ischemia. During the follow up, we registered the incidence of ischaemic events (admission for unstable angina, acute myocardial infarction (AMI) or cardiovascular (CV) death) and other CV events such as admission for heart failure (HF) and stroke. Additionally, we evaluated patients in both groups who underwent coronary angiography (by computerized tomography or coronary catheterization) during the follow up period. The groups with negative SE (NSE) and positive SE (PSE) were compared.

Results

The total number of patients was 344, with a median follow up of 29 months. Basal population characteristics and events by group (NSE and PSE) are shown in Figure 1. We needed to use the antidote in only one case, because of ventricular bigeminism, with no other major adverse effects reported. SE was positive in 37 (11%) patients. In this group, patients were more likely to present ischaemic events (16% vs. 3%, p<0.01) and admissions for HF (24% vs. 5%, p <0.01), compared to the NSE one. In those who underwent coronary angiography, revascularization was needed in 14 patients of the PSE group, and only in 7 of the NSE group (38% vs 2%, p < 0.05). The indications for these last cases were persistent angina in 5 patients (2 of them with history of coronary artery disease) and revascularization following an AMI in 2 patients. (Figure 2).

Conclusions

The probability of an ischaemic event after a negative Regadenoson SE remains very low, unlike positive studies. Regadenoson SE showed to be both safe in assessing ischemic cardiomyopathy and very useful for its prognostic value. These findings encourage its expanding use in the stress echo lab.
Prognostic significance of coronary flow velocity reserve in patients with peripheral arterial disease
Authors: Cerracchio E , Cortigiani L , Gaibazzi N , Ciampi Q , Tuttolomondo D , Navacchi R , Bovenzi F , Carerj S , Pepi M , Pellikka P A , Picano E
Published: October 2024

Background

Patients with lower extremity peripheral arterial disease (PAD) have a higher risk of cardiovascular events. Stress echocardiography (SE) based on regional wall motion abnormality (RWMA) is imperfect for risk stratification in PAD, but it can be complemented with an assessment of coronary flow velocity reserve (CFVR) in the mid-distal left anterior descending coronary artery.

Purpose

To assess the value of SE with RWMA and CFVR to predict survival in PAD.

Methods

In a retrospective analysis of prospectively acquired data in an observational, multicenter study, we recruited 359 patients (age 69±8 years, 240 [67%] males) with PAD referred for dipyridamole SE in 3 accredited laboratories. We assessed RWMA and CFVR (abnormal value <2.0). All patients were followed up for a median of 4.7 (interquartile range: 2.0 to 8.2 years). All-cause death was the outcome end-point.

Results

The positivity rate was 37/359 (10%) for RWMA and 159/359 (44%) for CFVR. During follow-up, 97 (27%) deaths were registered. At multivariable analysis, inducible RWMA and/or CFVR <2.0 (HR 2.58, 95% CI 1.65-4.04; p<0.0001), age ≥70 years, diabetes, dialysis treatment, and ejection fraction ≤50% were associated with decreased survival. The annual mortality was 7.4% in patients with RWMA and/or CFVR <2.0 and 2.7% in those with no RWMA and CFVR >2.0 (Figure, p<0.0001).

Conclusion

In patients with PAD, SE shows more than 4-fold higher prevalence of abnormal CFVR compared to RWMA. The prognostic value of CFVR outperforms RWMA, showing the importance of coronary microvascular dysfunction and diffuse, subcritical coronary atherosclerosis in determining the outcome.
Association of left atrial strain and exercise capacity among patients with hypertension: a single center study
Authors: Luna D
Published: October 2024

Introduction

Hypertension has been identified as one of the leading risk factors for developing cardiovascular disease in the Philippines. 1 The long term increase in afterload causes the progressive decline in both the systolic and diastolic function of hypertensive patients. There has been an increasing recognition in the role of left atrial function in the pathophysiology of several cardiac diseases, including hypertension.

Purpose

For patients with hypertension, exercise capacity is reduced by 30%.2 As exercise capacity is a known prognostic marker for adverse cardiovascular outcomes, identifying patients with hypertension with impaired left atrial reservoir strain may also improve cardiovascular risk stratification. With the use of two-dimensional (2D) speckle tracking echocardiography, left atrial strain can now be utilized in the evaluation of left atrial reservoir, conduit, and contractile function. Left atrial strain (LA strain) can now serve as a biomarker of adverse cardiovascular outcomes, including the exercise capacity of patients. Another goal of the study is to identify other clinical and echocardiographic factors that may affect exercise capacity

Methods

A single center, retrospective cross sectional study was conducted in a tertiary hospital to validate the association of left atrial strain with exercise capacity in terms of metabolic equivalent (METs) achieved during treadmill exercise echocardiography of patients diagnosed with hypertension. The primary objective of this study is to determine the left atrial strain cutoff that reliably discriminates poor, fair, average, good, or high exercise capacity. Data was obtained by conducting a chart and echocardiography review of adult patients from January 2023 to April 2023. The independent association of LA strain with METs was studied with regression analysis. Results were considered significant at p≤0.05 at 95% confidence interval. Receiver-operating characteristic curve analysis was utilized to determine the strength of the LA strain to discriminate between the different exercise capacities.

Results

A total of 136 patients were included in the study. LA strain, particularly the reservoir, can discriminate exercise capacity, specifically to discriminate good to high capacity from fair to average as their AUC is 0.678 (95% CI 0.58 to 0.77, p=.0001). The best cut-off is 30.2 which resulted to 80% sensitivity (95% CI 66.3 to 90) while specificity is only 51.16% (95% CI 40.1 to 62.1). Spearman rank correlation analysis showed that LA reservoir is significantly correlated with E/A and E/e’. The relationships are linear and positive. Among the other 2D echo parameters, only EDV, E/a and E/e’ were found to have a linear relationship or correlation with METS.

Conclusion

The study revealed that there is moderate correlation of LA reservoir strain in terms of METS achieved during treadmill stress echocardiography (rs=0.3196, p=0.0001).LA reservoir strain AUCLA strain and other echo parameters
Exercise Doppler echocardiography to detect early changes in the right ventricular-pulmonary circulation unit after pulmonary embolism
Authors: Morvai-Illes B , Vass A , Ruzsa Z , Jdid M S , Szili-Torok T , Varga A , Agoston G
Published: October 2024

Introduction

After pulmonary embolism (PE), patients frequently complain about reduced exercise capacity and dyspnea on exertion, even without pulmonary hypertension (PH). The underlying condition is often chronic thromboembolic disease, which is caused by residual pulmonary obstruction with preserved resting pulmonary haemodynamics. The symptoms are the consequences of the increased dead space ventilation, exercise-induced PH and right ventricular (RV) dysfunction.

We aimed to assess the pathologic differences in the echocardiographic parameters of the RV- pulmonary circulation unit among patients with previous PE and the healthy control group.

Furthermore, an objective was to compare the hemodynamic response to stress after different treatment strategies (thrombolysis vs. heparin administration).

Methods

21 patients after PE (mean age 58,5±12,1 years; 53% men) have been included in the study. All of them were effectively anticoagulated for at least three months, and none had any signs of PH on echocardiography at rest. The control group included 20 healthy volunteers (mean age 56,9±11,5 years; 55% men). Each patient underwent resting and exercise stress echocardiography on a semi-recumbent bicycle ergometer according to a standardised protocol until the maximally tolerated workload. Echocardiography was performed at rest, at 50 Watt workload and during peak stress. The measurements focused on the RV's systolic function (TAPSE), the estimated pulmonary artery systolic pressure (PASP), and the Doppler measurements in the RV and left ventricular outflow tracts. Pulmonary vascular resistance (PVR) and RV-pulmonary artery coupling (RV-PA) were calculated from the echocardiographic parameters.

Results

The post-PE group had significantly higher PASP (39,2 ±16,6 vs. 27,7±12,5 mmHg; p<0,05) and PVR (1,5±0,4 vs. 1,1±0,3 Wood Units; p<0,05) at peak stress, than the controls. 55% of post-PE patients remained symptomatic, but there were no significant differences between the symptomatic and asymptomatic groups regarding TAPSE, PASP, RV-PA coupling and PVR. 30% of post-PE patients had thrombolysis. In the patients where thrombolysis was performed, the coupling at peak stress was significantly higher than in heparin-treated patients (1,4±0,1 vs 0,9±0,4 mm/mmHg, p<0,05).

Conclusion

Post-PE patients without resting PH have higher PVR and PASP than the healthy control group, even after at least 3 months of adequate therapy. Post-PE patients treated with thrombolysis may have more preserved RV-PA coupling than the heparin-treated patients.
Early echocardiographic changes and reverse remodeling after transcatheter aortic valve implantation
Authors: Kaya E , Andresen K , Aaberge L , Edvardsen T , Skulstad H
Published: October 2024

Introduction

Our hospital is a tertiary centre performing more than 500 transcatheter aortic valve implantation (TAVI) procedures annually. In this study we present early echocardiographic changes post-TAVI.

Methods

Clinical data collection and comprehensive echocardiography was performed the day before and 3.5±1.6 months after TAVI. Data analysis compared pre- and post-TAVI evaluations.

Results

A total of 101 patients were analyzed. Mean age was 80.1±6.8 years and 40% were female. TAVI was performed transfemorally in all patients, with 83% receiving a balloon expandable valve. NYHA class improved from 2.5±0.6 to 1.4±0.5 after TAVI (p<0.001) Echocardiographic parameters are summarized in Table. Global longitudinal strain (GLS) improved from -17±4% pre-TAVI to -18±4% post-TAVI (p<0.001), with no notable change in LVEF. A significant reverse remodeling with ≥10% reduction in left ventricular mass index (LVMi) was observed in 52% of patients following TAVI (from 124±32 to 110±29 g/m2, p<0.001) (Figure). Predictors of LVMi reduction were pre-TAVI LVMi and absence of comorbid hypertension (OR=1.02, 95% CI=1-1.03, p=0.03 and OR=0.31, 95% CI=0.11-0.84, p=0.02 respectively). There was no significant improvement in diastolic function, including left atrial strain.

Conclusions

Early post-TAVI assessments showed significant reverse remodelling with improvements in GLS and LVMi after TAVI. Predictors of LVMi reduction post-TAVI were absence of comorbid hypertension and higher baseline LVMi. There was no notable changes in diastolic function.
Revisiting echocardiographic ranges of left ventricular end-diastolic volume index: an analysis of the discrepancies between the 2006 and the 2015 recommendation for chamber quantification guidelines
Authors: Larti F , Fallahtafti P , Bahramrafiee R , Sattarzadeh Badkoubeh R , Sardari A , Eftekhari M , Geraiely B , Safari S
Published: October 2024

Background

Indexed left ventricular end-diastolic volume (LVEDVi) and indexed left ventricular end-diastolic diameter (LVEDDi) serve as crucial parameters indicative of left ventricle (LV) size. The "Recommendations for Chamber Quantification" guideline was published in 2006 and updated in 2015. While the previous guideline maintained uniform cut-off points for both men and women, the latest revision introduced new thresholds that vary between genders.

Purpose

The study's primary aim is to evaluate the extent of change in labeled indexed LV diastolic volumes in men and women following the adoption of the 2015 guidelines and identify potential contributing factors to this change.

Methods

In this cross-sectional study, we analyzed echocardiography data extracted from a web-based registry from March 2020 to October 2022. LV volume variables were categorized based on the indexed ranges specified in the 2006 and 2015 guidelines. Statistical analysis was performed using SPSS version 25.

Results

Among the 7598 individuals, the classification of LVEDDi according to the 2006 and 2015 guidelines differed in 456 (6.1%) subjects. The classification of LVEDVi differed in 910 (12.0%) individuals. In 213 (5.5%) female subjects initially categorized as having normal or mild LV enlargement according to the 2006 guideline, there was substantial reclassification following the application of the 2015 recommendation (i.e., transitioned from a normal classification to moderate LV enlargement and from mild to severe LV enlargement). All females classified as having moderately abnormal LVEDVi according to the 2006 guideline were reclassified as having severely abnormal LVEDVi according to the 2015 guideline.

Conclusion

The significant disparities observed in the classification of indexed LV volumes between the 2006 and 2015 guidelines underscore the importance of ongoing dedicated research to reassess the range of indexed echocardiographic parameters, considering various outcomes and differences in countries and races.
Multiorgan congestion assessment by venous excess ultrasound score in acute heart failure
Authors: Anastasiou V , Peteinidou E P , Moysidis D V M , Daios S D , Gogos C G , Liatsos A C L , Didagelos M D , Gossios T G , Efthimiadis G K E , Karamitsos T K , Delgado V D , Ziakas A Z , Kamperidis V K
Published: October 2024

Purpose

Congestion assessment in patients with heart failure (HF) remains challenging and currently relies on clinical judgment, while validated methods to quantify congestion are lacking.

Aim

This study sought to explore the prevalence and clinical utility of different patterns of multi-organ venous congestion as assessed by the Venous Excess Ultrasound (VExUS) score in hospitalized patients with HF.

Methods

Consecutive patients admitted for acute HF were prospectively enrolled. Inferior vena cava (IVC) diameter, hepatic vein, portal vein and renal vein Doppler waveforms were assessed at admission and patients were stratified based on VExUS score from 0 to 3, with higher values indicating worse congestion (Picture 1). The clinical score Get With The Guidelines (GWTG)-HF for predicting in-hospital mortality in HF was evaluated. In-hospital mortality was recorded.

Results

Two-hundred-ninety patients admitted with acute HF were included and 114 (39%) of them were classified as VExUS score 3 which was the most prevalent group. Patients with VExUS score 3 suffered more frequently from chronic atrial fibrillation, chronic kidney disease and anemia. Parameters independently associated with VExUS score 3 were higher mean E/e’ ratio, larger right ventricular size, severe tricuspid regurgitation and impaired right atrial function. VExUS score 3 was associated with in-hospital mortality [OR 8.03, 95% CI (2.25–28.61), p=0.001]. The addition of VExUS score on top of the GWTG-HF score improved the predictability of the model (Δx2=+8.44, p=0.03) for in-hospital mortality, whereas other indices of venous congestion (right atrial function, IVC size) did not (Picture 2).

Conclusion

Patients admitted with acute HF commonly had severe venous congestion based on VExUS score. VExUS score improved the prediction of in-hospital mortality as compared to other indices of venous congestion.VExUS and adverse cardiac remodelingModels for in-hospital mortality
Artificial intelligence to detect pulmonary congestion on chest computed tomography in consecutive dyspnoeic patients
Authors: Miger K , Overgaard Olesen A , Orting S , Petersen J , De Bruijne M , Grand J , Ploug Boesen M , Thune J J , Wendelboe Nielsen O
Published: October 2024

Background

Pulmonary congestion is a hallmark of acute heart failure (AHF), and essential for the diagnosis, treatment, and risk stratification.

We have previously shown that a low-dose chest CT has four times greater odds than chest radiographs to detect pulmonary congestion. However, implementation is limited by shortage of radiologists. We hypothesized that artificial intelligence (AI) can detect pulmonary congestion on chest CT and aimed to develop and validate an AI-algorithm to detect pulmonary congestion on chest CT.

Methods

We extracted all chest CT-scans ordered acutely (N= 4840 unique patients) by medical departments at X Hospital from 2016-2021. A random subset of these CT-scans (N= 2187) was used to develop an AI-algorithm to detect pulmonary congestion, using the radiology reports as reference. The remaining subset (N= 1094) was used for internal validation.

We externally validated the AI-algorithm in a different cohort (X), comprising of 236 consecutive dyspnoeic patients admitted to the emergency department, all examined with a low-dose, non-contrast chest CT (LDCT). The primary outcome was pulmonary congestion adjudicated by clinical on-call radiologists with access to the medical record, and two independent, blinded research thoracic radiologists. The default AHF thresholds for the optimal cut-off, rule-in threshold and rule-out threshold was established from the internal validation.

Results

Of 236 patients (median age 74 years, 57% male), 62 (26%), 64 (27%) and 60 (26%) had pulmonary congestion on LDCT evaluated by the on-call radiologists and the two thoracic research radiologists, respectively.

The AI-algorithm included ten discriminating features of pulmonary congestion, and the results demonstrate an AUC of 0.95 [95%CI: 0.93-0.98] to predict pulmonary congestion by the on-call radiologists. The results were confirmed by the two expert research radiologists, with an AUC of 0.91 [95%CI: 0.88-0.95] and 0.94 [95%CI: 0.90-0.97], respectively.

The sensitivity and specificity of the AI-default threshold was 89% [95%CI: 78-95%] and 89% [95%CI: 83-93%], respectively. The rule-in threshold demonstrated a sensitivity of 97% [95%CI: 86-100%] and the rule-out threshold had a specificity of 96% [95%CI: 92-98%], Figure 1.

Conclusion

We developed and validated a novel AI-algorithm with promising potential for the rapid automatic detection of pulmonary congestion as the underlying cause of dyspnoea in consecutive acute patients.
Effect of empagliflozin on epicardial adipose tissue volume in patients with type 2 diabetes, or prediabetes, and heart failure with reduced ejection fraction (SUGAR-DM-HF)
Authors: Turgut C , Fernando J , Berry C , Campbell R T , Docherty K F , Dreisbach J G , Jhund P S , Mangion K , Mark P B , Mcmurray J J V , Osmanska J , Roditi G , Petrie M C , Sattar N , Lee M
Published: October 2024

Background

Epicardial adipose tissue (EAT) is postulated to be linked to the pathophysiology of heart failure with reduced ejection fraction (HFrEF), acting both as a biomarker and a potential therapeutic target. Investigating changes in EAT volume following treatment with sodium-glucose cotransporter 2 (SGLT2) inhibitor could provide valuable mechanistic insights.

Purpose

This posthoc substudy of the SUGAR-DM-HF trial aimed to assess the effect of the SGLT2 inhibitor empagliflozin on EAT volume.

Methods

Within a multicentre, randomised, double-blind, placebo-controlled trial, the effects of empagliflozin were evaluated in patients with HFrEF (New York Heart Association functional class II-IV, left ventricular ejection fraction (LVEF) ≤40%), and type 2 diabetes or prediabetes. Patients with atrial fibrillation/flutter were excluded to avoid image degradation. Patients were randomly assigned 1:1 to empagliflozin 10mg daily or placebo. EAT volume was quantified using cardiovascular magnetic resonance (CMR) cine imaging at baseline and week 36, and reported as: (a) total EAT volume (mL); (b) EAT volume indexed to body surface area (mL/m2); (c) % change from baseline. Observers were blinded to subject identification, scan date, clinical data, and randomization arm. Scans with major artefacts were not analysed.

Results

One hundred five patients were randomly assigned: mean age 68.7 (SD, 11.1) years, 77 (73.3%) male, 82 (78.1%) diabetes and 23 (21.9%) prediabetes, mean LVEF 32.5% (9.8%). Baseline EAT volume was available in 101 patients (median [IQR] 85 [67-104] mL and 41 [34-52] mL/m2). Paired baseline and 36-week EAT volume was available in 90 patients. Higher baseline total EAT volume was associated with male gender, higher body mass index, coronary artery disease, elevated serum creatinine, higher left ventricular end-diastolic volume, and higher left ventricular mass (TABLE). EAT volume changed by -2.7 mL / -1.3 mL/m2 / -3.1% in the empagliflozin group versus 0.3 mL / 0.3 mL/m2 / 1.5% in the placebo group (between-group difference -3.4 mL, 95% CI -6.7 to -0.1; p=0.045 and -1.7 mL/m2, 95% CI -3.4 to -0.04; p=0.045) at 36 weeks (FIGURE). The beneficial reduction in left ventricular end-systolic volume indexed to body surface area observed with empagliflozin treatment was not modified by baseline total or indexed EAT volumes (p interaction=0.31 and 0.45, respectively).

Conclusion

Empagliflozin treatment significantly reduced EAT volume. This may represent an additional benefit of SGLT2 inhibition in HFrEF.
Left atrial reservoir strain and global longitudinal strain associates with re-hospitalization and mortality in patients admitted for acute heart failure
Authors: Zilic H , Holm H , Jujic A , Magnusson M
Published: October 2024

Background

Left atrial reservoir strain (LAr) and global longitudinal strain (GLS) have emerged as useful parameters for the assessment of left ventricular diastolic function and the estimation of left ventricular filling pressures. Yet, there remains a gap of knowledge regarding the possible association of LAr and GLS with re-hospitalization and mortality in patients with acute heart failure (HF).

Aims

This study aims to investigate the association between LAr and GLS with re-hospitalization and mortality in patients admitted for acute HF.

Methods

Out of 526 enrolled patients admitted for acute HF, 142 (mean age 71, 25% women) were systematically evaluated for LAr and GLS using speckle tracking echocardiography. Multivariable Cox regression analyses, adjusting age, sex, current smoking prevalent atrial fibrillation, hypertension, kidney disease and plasma glucose, were used to assess the associations between continuous values of LAr and GLS with all-cause mortality and HF-related re-hospitalization.

Results

The median follow-up time to death of any cause and HF rehospitalization was 39 (interquartile range 14-66) and 22 (4-51) months, respectively. During follow up, 63 (44%) patients died, and 63 (44%) were re-hospitalized due to HF. Lower values of LAr were significantly associated with higher risk of mortality (HR 0.93; 95%CI 0.89-0.98, p=0.008). Similarly, lower GLS was associated with higher risk of mortality (HR 0.94; 95%CI 0.89-0.99, p=0.045). Only lower values of LAr were associated with higher risk of HF re-hospitalization in the multivariable model (HR 0.93; 95%CI 0.88-0.98, p=0.004).

Conclusion

In this prospective, long-term follow-up study of patients with acute heart failure, lower values of LAr and GLS showed prognostic significance, with lower values being indicative of poorer outcomes. Notably, LAr was associated with higher risk of both death and rehospitalization for heart failure, whereas GLS was solely associated with higher mortality risk. These echocardiographic parameters could be further investigated for risk assessment of patients with heart failure in order to identify those at higher risk of rehospitalization and death, thereby facilitating targeted interventions to improve their prognosis.KM-curves for or the Quartiles of LAr
Relationship between changes in renal function after acute phase of tafamidis administration and left ventricular diastolic function at mid-term follow-up in transthyretin cardiac amyloidosis
Authors: Senda A , Fujiwara M , Ichikawa Y , Yokota H , Noiri J , Nagano T , Takeuchi M , Nagai S , Nishihara Y , Uemura K , Odajima S , Kintsu M , Hisamatsu E , Hirata K , Tanaka H
Published: October 2024

Background

A large number of heart failure (HF) patients present with various degrees of renal dysfunction, known as cardio-renal syndrome. Renal impairment in HF patients is also associated with an independent risk factor for morbidity and mortality. Transthyretin (TTR) amyloidosis (ATTR) is characterized by disintegrated liver-derived TTR that accumulates as amyloid fibrils in the myocardium, leading to initially presenting as left ventricular (LV) hypertrophy and LV diastolic dysfunction. Although there is no proven therapy for patients with ATTR cardiomyopathy (ATTR-CM), tafamidis meglumine, a TTR stabilizer, has been associated with favorable outcomes. Although the kidneys are also an important organ where amyloid deposition occurs, the effect of tafamidis on renal function and its relationship to LV diastolic function is unclear.

Purpose

The purpose of this study was to investigate the relationship between changes in renal function after the acute phase of tafamidis administration and LV diastolic function at mid-term follow-up in patients with ATTR-CM.

Methods

We studied 56 patients with biopsy-proven ATTR-CM who were treated with tafamidis. All patients underwent blood examinations before and 45.6 ± 23.0 days after the acute phase of tafamidis administration. Echocardiography was performed before and 15.6 ± 9.8 months after the mid-term of tafamidis administration. The primary endpoint was defined as a composite of cardiovascular death or HF hospitalization for 5.0 years.

Results

Twelve patients had improved renal function as assessed by estimated glomerular filtration rate in the acute phase after tafamidis administration, while 44 patients deteriorated. In the group with improved renal function in the acute phase after tafamidis administration, pulsed-wave Doppler-derived early diastolic velocity from the septal mitral annulus (E’) and left atrial volume index (LAVI) tended to improve at mid-term follow-up compared to the non-improved group. (E’: 0.8 ± 1.7 cm/s vs. 0.2 ± 1.1 cm/s, p=0.127, LAVI: -8.7 ± 12.0 mL/m2 vs. 0.2 ± 16.8 mL/m2, p=0.093). Furthermore, Kaplan-Meier curve indicated that the occurrence of cardiovascular events for patients with improved renal function in the acute phase after tafamidis administration tended to be lower than those without (log-rank P=0.137).

Conclusions

The improvement of renal function in the acute phase after tafamidis administration was associated with the improvement of LV diastolic function at mid-term follow-up, leading to favorable outcome. Our findings may provide new insights for the management of patients with ATTR-CM.
Association between GDF-15 levels and cardiac morphology and function in cardiac magnetic resonance imaging: insights from UK Biobank data analysis
Authors: Sadowski J , Cyganski P , Nowek P , Bartos B , Zajac K , Rynkiewicz A , Morze J
Published: October 2024

Background/Introduction

Growth Differentiation Factor-15 (GDF-15) has emerged as a biomarker associated with cardiovascular disease and adverse cardiac outcomes. Cardiac morphology and function, assessed through cardiac magnetic resonance imaging (CMR), are critical indicators of cardiovascular pathology. Understanding the relationship between GDF-15 levels and LV characteristics could provide valuable insights into cardiac pathophysiology and disease progression.

Purpose

This study aims to investigate the association between GDF-15 levels and cardiac morphology and function, utilizing data from the UK Biobank and CMR. By analyzing various CMR-derived parameters, including LV strain, myocardial mass, LV mass-to-volume ratio, ventricular and atrial volumes, we seek to elucidate the impact of GDF-15 on cardiac structure and function.

Methods

Data from the UK Biobank, including 2,264 participants, were analyzed. The median age of the analyzed participants was 55 years, with a median BMI of 26.0. Among the participants, 53% were females and 47% were males. CMR-derived variables related to cardiac morphology and function, along with GDF-15 levels, were examined. Multiple linear regression models were constructed to assess the association between GDF-15 levels and cardiac parameters, adjusting for age, sex, and other relevant covariates. Confidence intervals (CI) and p-values were calculated to determine the significance of observed associations.

Results

Analysis of the UK Biobank data revealed significant associations between GDF-15 levels and specific cardiac parameters (table1). Notably, GDF-15 levels were negatively associated with LV myocardial mass (LVM)(coefficient = -1.146, p = 0.0071), LV end-diastolic volume LVEDV)(coefficient = -3.321, p < 0.0001), LV end-systolic volume (coefficient = -1.876, p < 0.0001), as well as right atrial maximum volume (coefficient = -3.025, p < 0.0001) and minimum volume (coefficient = -1.858, p = 0.0003). In addition, LVM/LVEDV was positively associated with GDF-15 level (p<0.03). However, no significant associations were observed between GDF-15 levels and LV strain parameters, ejection fraction, or left atrial volumes.

Conclusion

This study provides evidence of a significant association between GDF-15 levels and selected parameters of cardiac morphology and function, as assessed by CMR in the UK Biobank population. These findings suggest a potential role of GDF-15 in modulating specific aspects of cardiac structure, function and left ventricle concentric remodeling warranting further investigation.GDF 15
Epicardial adipose tissue volume and density are associated with heart failure with improved ejection fraction
Authors: Yang C D , Wang X Q
Published: October 2024

Background

Heart failure (HF) with improved ejection fraction (EF, HFimpEF) gains increasing attention as a distinct HF subtype, characterized by left ventricular reverse remodeling and myocardial recovery. Multiple cardiometabolic factors are implicated in this process. Epicardial adipose tissue (EAT), emerging as an endocrine and paracrine organ, contributes to the onset and progression of HF. However, the relation between EAT and the incidence of HFimpEF is still unclear.

Methods

A total of 203 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) who underwent coronary CT angiography (CCTA) during index hospitalization were consecutively enrolled between November 2011 and December 2022. Routine follow-up and repeat echocardiograms were performed. The incidence of HFimpEF was defined as (1) an absolute EF improvement ≥10% and (2) a second EF > 40% (at least 3 months apart). EAT volume and density were semiautomatically quantified on non-enhanced series of CCTA scans.

Results

During a median follow-up of 8.6 (4.9~13.3) months, 104 (51.2%) patients developed HFimpEF. Compared with HFrEF patients, HFimpEF patients had lower EAT volume (126.03 ± 57.71 cm3 vs 182.74 ± 82.99 cm3 , P< 0.001) and higher EAT density (-74.92 ± 6.84 HU vs -78.76 ± 6.28 HU, P< 0.001) both in ischemic and non-ischemic HF patients. EAT density was inversely correlated with EAT volume (r= -0.33, P< 0.001). Multivariate analysis showed lower EAT volume (OR: 0.881 [95% CI 0.821~0.939]) and higher density (OR: 2.354 [95% CI 1.314~4.415]) were both independently associated with the incidence of HFimpEF, after adjusting for conventional risk factors, pharmacological therapies and baseline anthropometric parameters including body mass index. Subgroup analysis revealed that the association between EAT properties and HFimpEF was not modified by HF etiology.

Conclusions

This study reveals that lower EAT volume and higher EAT density are associated with development of HFimpEF. Therapies targeted at reducing EAT quantity and improving its quality might provide favorable effects on myocardial recovery in HF patients.
Heart failure hospitalization reduction and long-term safety with remote pulmonary artery pressure monitoring: results of the CardioMEMS HF System OUS Post-Market Study
Authors: Roubille F , Mckenzie S , Flett A , Folley P , Rossing K , Ciccarelli M , Pouleur A C , Gazzola C , Park E , Adamson P B , De Groote P
Published: October 2024

Background

Heart failure (HF) is increasing in prevalence and is responsible for frequent hospitalization and readmissions, despite current guideline recommended therapies. Hemodynamic guided HF management using frequently remotely obtained pulmonary artery (PA) pressure information using a permanently implanted PA sensor (CardioMEMSTM HF System, Abbott) consistently reduced HF hospitalizations (HFH) in multiple healthcare settings.

The safety and efficacy of the CardioMEMS HF System has been shown previously in several clinical studies, which reported significant reductions in HFH compared to a control (CHAMPION: 33%, 18M; GUIDE-HF: 28%, 1 yr; and MONITOR-HF: 44%, 1 yr) and longitudinally (MEMS-HF: 62%, 1 yr; and CardioMEMS US PAS: 57%, 1 yr) across varying health systems.

Purpose

The CardioMEMS HF System OUS Post-Market Study (COAST) aimed to evaluate the safety and effectiveness of hemodynamic guided HF management in patients with NYHA Class III HF in varying health systems across Europe and Australia.

Methods

COAST is a prospective, multi-centre, open-label clinical trial that consented 321 patients at 38 European and Australian centres. The primary endpoint is a combination of safety (freedom from DSRCs and freedom from pressure sensor failure at 2 years after implant) and efficacy endpoints (annualized HFH rate at 1-year vs the HFH rate in the year prior to enrolment). In this analysis we report these primary results of the study.

Results

Out of 321 consented patients, 17 subjects were withdrawn before implant, while the PA sensor was implanted successfully in 299 out of 304 patients who underwent the procedure (98.3% success rate). Seventy-three percent (73%) of the patients were male, the mean age was 68.4±11.7 years with ischemic cardiomyopathy in 45.4%. At baseline, all patients had NYHA Class III symptoms and an average EQ-5D-5L VAS score of 60.0±21.6. After 2 years follow-up there was 100% freedom from DSRCs and 99.7% freedom from pressure sensor failure. The annualized HFH rate after 1 year decreased by 69%, from 1.586 (pre-implant) to 0.488 (post-implant) (p<0.0001). The patient’s quality of life (EQ-5D-5L VAS) increased 8.1 units (68.2 ± 20.1, p=0.0008).

Conclusion

The COAST Study demonstrated that hemodynamic-guided remote HF management using PA pressure information is both safe and effective, with consistent implant safety and low risk for long-term sensor failure. At 1 year post implant, HFH were significantly reduced and quality of life improved. These results are also consistent with long-term clinical follow-up (2 yr) in other geographies with no late-stage adverse events or adverse events from sensor implant, demonstrating the generalizability of this type of hemodynamic-guided HF management.
OptiHeart: determinants and prognostic importance of optimal medical treatment in patients with heart failure discharged from the heart failure clinic
Authors: Sharfo A , Sorensen A L , Nielsen E E , Olsen M H , Raymond I E , Soja A M B
Published: October 2024

Background

Heart failure (HF) is an increasing health problem globally. Current guidelines are based on studies with primarily male patients. Females are less likely to receive target dose of HF medication as recommended by the clinical guidelines. The reason for this is uncertain, but it has led to the question whether females might not need as high dosages as the males to achieve the beneficial effects of the HF medication.

Aim

To assess baseline predictors for achieving optimal medical treatment (OMT) and the prognostic importance of OMT for male and female patients who have attended a HF clinical program (HFCP).

Methods

OPTIHEART included 870 patients with left ventricular ejection fraction (LVEF) <45% leaving HFCP in 2018, 2019 or 2020 and followed in registers for a mean of 1083(SD 11.3) days. OMT was defined as receiving an angiotensin-converting-enzyme-inhibitor (ACEi), angiotensin-receptor blocker (ARB) or angiotensin-II-receptor blocker and nephrylisin-inhibitor (ARNI) AND a betablocker both in doses > 50% of target dose. Association between baseline data at referral and OMT at end of HFCP were calculated using logistic regression. The association between OMT and a 5-point Major Adverse Cardiovascular Event (a 5-Point MACE consisting of cardiovascular mortality, non-fatal acute myocardial infarction, non-fatal stroke, coronary revascularization, worsening of heart failure (both hospitalisation and re-referral to HFC)), were calculated and adjusted for other cardiovascular risk factors using multiple Cox-regression analyses.

Results

Achieving OMT was associated with male sex (OR: 2.05 95%CI 1.44-2.97; P<0.0001) independently of younger age, higher diastolic blood pressure (DBP), and lower creatinine at referral. A lower rate of 5-point MACE was associated achieved OMT (HR: 0.67 95%CI 0.50-0.89; P=0.006) independently of female sex (HR: 0.62 95%CI 0.47-0.82; P=0.002), younger age, never smoking and NYHA≤2. The beneficial effect of OMT was more pronounced in patients with BMI<26.5kg/m2 (HR=0.41[0.23-0.72] vs. HR=0.84[0.58-1.21], Pinteraction= 0.02), and insignificantly more pronounced in patients with male sex, older age, higher creatinine, and lower DBP.

Conclusion

OMT was more frequently achieved in patients with male sex independently of lower age, higher DBP, and lower creatinine. Achieving OMT was associated with less 5-point MACE independently of female sex, younger age, never smoking and NYHA≤2 and especially in patients with BMI<26.5kg/m2.Hazard RatioMedical treatment
Long-term effects of patisiran on survival and cardiac parameters in patients with transthyretin-mediated cardiac amyloidosis: post hoc analysis of APOLLO-B and cardiac subpopulation of APOLLO OLE
Authors: Lairez O , Algalarrondo V , Damy T , Donal E , Bender S , Bakdache A , Jay P Y , Adams D
Published: October 2024

Introduction

Transthyretin-mediated (ATTR) amyloidosis is a progressive, fatal disease in which the most serious manifestations are polyneuropathy and cardiomyopathy. Patients with hereditary ATTR (ATTRv; v for variant) amyloidosis commonly develop a mixed phenotype, and patients with wild-type ATTR amyloidosis predominantly have cardiomyopathy, although polyneuropathy may coexist. Patisiran, an RNAi therapeutic that rapidly knocks down TTR, has shown long-term benefit on measures of polyneuropathy in the APOLLO open-label extension (OLE) study in patients with ATTRv amyloidosis.

Purpose

To evaluate the long-term benefit of patisiran on survival, hospitalisations and cardiac parameters in a pooled cohort of patients with ATTR amyloidosis and evidence of cardiac involvement, across the patisiran clinical programme (Phase [Ph] 2 launched in 2012).

Methods

Post hoc analysis of pooled data from cardiac subpopulations of patients with ATTRv amyloidosis and polyneuropathy from 5-year Global OLE (Ph 2 OLE and Ph 3 APOLLO; patients with baseline left ventricular [LV] wall thickness ≥13 mm; absence of history of aortic valve disease or hypertension), and Ph 3 APOLLO-B (patients with wild-type or ATTRv cardiac amyloidosis). Patients received patisiran or placebo every 3 weeks for 18 months in APOLLO and 12 months in APOLLO-B; all patients received patisiran thereafter. Analyses included Kaplan-Meier estimates and Cox regression of survival and all-cause hospitalisations, and summary statistics of cardiac biomarkers and echocardiographic parameters by initial treatment arm.

Results

Pooled analysis included 496 patients (initial arm placebo, n=214; initial arm patisiran, n=282). Compared with placebo, patients initially receiving patisiran had better long-term survival and fewer hospitalisations (hazard ratio [95% confidence interval] over 84 months for all-cause mortality and all-cause hospitalisations: 0.59 [0.37–0.93] [Figure 1] and 0.77 [0.60–0.99], respectively). At baseline, NT-proBNP and troponin I levels, peak longitudinal strain and LV wall thickness were comparable between patisiran vs placebo-treated patients. Placebo-treated patients showed worsening of all these parameters whilst on placebo; the rates of worsening decreased once the patients initiated patisiran. In contrast, patients who initially received patisiran demonstrated relative stability over 84 months in the Global OLE and significant benefit compared with those initially treated with placebo.

Conclusion

Long-term benefit of patisiran in patients with cardiomyopathy was observed on survival, hospitalisations, cardiac biomarkers and echocardiographic parameters. Outcomes were significantly more favourable for those initially randomised to patisiran than placebo, highlighting the impact of initiating treatment early in the course of disease.