bluuebunny/crossref_metadata_2025 huggingface dataset:
External validation of an electrocardiography artificial intelligence-generated algorithm to detect left ventricular systolic function in a general cardiac clinic in Uganda
Authors: Mondo C.K , Attia Z.I , Benavente E.D , Friedman P , Noseworthy P , Kapa P , Ingabire P , Semanda S , Perel P , Lopez-Jimenez F
Published: November 2020

Background

Left ventricular systolic dysfunction (LVSD) is associated with increased morbidity and mortality. Although there are effective treatments for patients with LVSD to prevent mortality, heart failure and to improve symptoms, many patients remain undetected and untreated. We have recently derived a deep learning algorithm to detect LVSD using the electrocardiogram (ECG) which could have an important screening role, particularly in limited resources settings. We evaluated the accuracy of this algorithm for the first time in Africa in a sample of subjects attending a cardiology clinic.

Methods

We conducted a retrospective study in a general cardiac clinic in Uganda. Consecutive patients ≥18 years who had a digital ECG and echocardiogram done within two days of each other were included. We excluded patients with pacemakers or missing information regarding left ventricular ejection fraction (LVEF). Routine 10-second, twelve-lead surface rest ECG were performed using an Edan PC ECG Model SE-1515, Hamburg, Germany. The probability of LVSD was estimated with the Mayo Clinic artificial intelligence (AI) ECG algorithm. LVEF was calculated by the MMode (Teichholz method) using a Philips Ultrasound system, HD7XE, Bothel, Washington, USA. LVSD was defined as a LVEF≤35%. We assessed the overall diagnostic performance of the algorithm to identify LVSD in this population with the area under the receiver operating curve (AUC), and estimated sensitivity, specificity and accuracy using a pre-specified cut-off based on the probability for LVSD generated by the algorithm. We conducted secondary analyses using different LVEF cutoff values.

Results

We included 634 subjects, 32% (200) of whom had hypertension and 12% (77) clinical heart failure. Mean age was 57±18.8 years, 58% were women and the overall prevalence of LVSD was 4%. The AI-ECG had an AUC of 0.866 (see figure below), sensitivity 73.08%, specificity 91.10%, negative predictive value 98.75%, positive predictive value 26.03% and an accuracy of 90.96% using the original threshold. Using the optimal cutoff based on the AUCs, the sensitivity was 80.77% and specificity was 81.05% with a negative predictive value of 98.99%. The ROC for the detection of LVEF of 40% or below was 0.821.

Conclusion

The Mayo AI-ECG algorithm demonstrated good accuracy, sensitivity and specificity to detect LVSD in patients seen in a clinical setting in Uganda. This tool may facilitate the identification of people at a high risk for LVSD in settings with low resources.

ROC

Funding Acknowledgement

Type of funding source: None
Left atrial remodeling in heart failure: coexistence and additive prognostic power of atrial dilation and dysfunction
Authors: Rossi A , Carluccio E , Cameli M , Inciardi R , Mandoli G.E , D'Agostino A , Biagioli P , Pugliese N.R , Pastore M.C , Maffeis C , Mengoni A , Dini F.L
Published: November 2020

Background

Heart failure (HF) is associated with volumetric and functional changes of left atrium (LA).

Purpose

It is still unclear whether the two atrial abnormalities necessarily coexist and if they have additive prognostic implications.

Methods

690 patients with HF due to reduced left ventricular ejection fraction (EF) formed the study population. Each patients underwent comprehensive echocardiographic evaluation; atrial function was assessed by means of strain analysis during reservoir (PALS). End-point of the study was overall survival free of hospitalization.

Results

Patients were divided in 4 groups according to left atrial size (34 ml/mq) and function (PALS 20%). 64 patients (10%) were characterized by completely normal left atrium (group 1), 150 (25%) by dilated LA by normal PALS (group 2), 130 (20%) by normal LA volume but abnormal PALS (group 3) and 200 patients with dilated LA and decreased PALS (group 4). Clinical and echocardiographic characteristics of the groups are presented in the table. Decreased PALS was associated with worse survival both in patients with normal and abnormal LA volume (p<0.0001 for each group).

Conclusions

Increased volume and decreased function of LA frequently but not necessarily coexist. LA functional impairment affects prognosis independently of LA volume.

Funding Acknowledgement

Type of funding source: None
Association between self-care and prognosis in 1123 patients with chronic heart failure
Authors: Calero E , Hidalgo E , Marin R , Rosenfeld L , Fernandez I , Garay A , Alcoberro L , Jimenez S , Yun S , Guerrero C , Moliner P , Delso C , Alcober L , Enjuanes C , Comin-Colet J
Published: November 2020

Background

Self-care is a crucial factor in the education of patients with heart failure (HF) and directly impacts in the progression of the disease. However, little is published about its major clinical implications as admission or mortality in patients with HF.

Aims and methods

The aim of the study was to analyze time to admission due to acute heart failure and mortality associated with poor self-care in patients with chronic HF.

We prospectively recruited consecutive patients with stable chronic HF referred to a nurse-led HF programme. Selfcare was evaluated at baseline with the 9 item European Heart Failure Self-Care Behavior Scale. Scores were standardized and reversed from 0 (worst selfcare) to 100 (better self care). For the purpose of this study we analyzed the associations of worse self-care (defined as scores below the lower tertile of the scale) with demographic, disease-related (clinical) and psychosocial factors in all patients at baseline.

Results

We included 1123 patients, mean age 72±11, 639 (60%) were male, mean LVEF 45±17 and 454 (40,4%) were in NYHA class III or IV. Mean score of the 9-item ESCBE was 69±28. Score below 55 (lower tertile) defined impaired selfcare behaviour.

Those patients with worse self-care had more ischaemic heart disease, more COPD, and they achieved less distance in the 6 minute walking test. Regarding psychosocial items patients in lower tertile of self-care needed a caregiver more frequently, they present more cognitive impairment, depressive symptoms and worse score in terms of health self-perception.

Multivariate Cox Models showed that a score below 55 points in 9-item ESCBE was independently associated with higher readmission due to acute heart failure [HR 1.26 (1.02–1.57), p value=0.034] and with mortality [HR 1.24 CI95% (1.02–1.50), p value=0.028]

Conclusion

Poor self-care measured with the modified 9-item ESCBE was associated with higher risk of admission due to acute decompensation and higher risk of mortality in patients with chronic heart failure.

These results highlight the importance of assessing self-care and provide measures to improve them.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): Hospital Univesitario de Bellvitge
Cost-effectiveness of dapagliflozin in chronic heart failure: an analysis from the Australian healthcare perspective
Authors: Savira F , Wang B.H , Kompa A.R , Ademi Z , Owen A , Tonkin A , Zoungas S , Liew D , Zomer E
Published: November 2020

Background

The Dapagliflozin and Prevention of Adverse Outcomes in Heart Failure (DAPA-HF) trial demonstrated that dapagliflozin reduced heart failure hospitalisations and mortality in patients with established heart failure, regardless of diabetic status.

Purpose

To assess the cost-effectiveness of dapagliflozin in addition to standard care versus standard care alone in patients with chronic heart failure, from the perspective of the Australian public healthcare system.

Methods

A Markov model populated with 1000 hypothetical individuals was constructed based on the DAPA-HF trial to assess the clinical outcomes and costs of patients with established heart failure and reduced ejection fraction over a lifetime time horizon. The model consisted of three health states: “Alive and event-free”, “Alive after non-fatal hospitalisation for heart failure” or “Dead”. Costs and utilities were estimated from published sources. Outcomes of interest were the incremental cost-effectiveness ratios (ICERs) in terms of cost per quality-adjusted life year (QALY) gained and cost per year of life saved (YoLS). All outcomes were discounted at a rate of 5% annually.

Results

Over a lifetime analysis, addition of dapagliflozin to standard care in patients with chronic heart failure prevented 88 acute heart failure hospitalisations (including readmission), and saved 416 (discounted) years of life and 288 (discounted) QALYs, at an additional cost of A$3,692,440 or €2,263,204 (discounted). This resulted in ICERs of A$8,875 (€5,439) per YoLS and A$12,482 (€7,650) per QALY gained, well below the Australian arbitrary willingness-to-pay threshold of A$50,000 (€30,645).

Conclusion

From the Australian public healthcare perspective, dapagliflozin is cost-effective when used as an adjunct therapy to standard care compared to standard care alone for the treatment of chronic heart failure with reduced ejection fraction.

Funding Acknowledgement

Type of funding source: None
Nanoparticles loaded with hepatic growth factor and insulin-like growth factor-1 improve left ventricular repair in a porcine model of myocardial Ischemia reperfusion injury
Authors: Wu M , Claus P , De Buck S , Veltman D , Gillijns H , Holemans P , Pokreisz P , Caluwe E , Colino E , Cohen S , Prosper F , Pelacho B , Janssens S
Published: November 2020

Introduction

Nanomedicine offers great potential for treatment of cardiovascular disease. We tested whether intramyocardial (IM) injection of pro-angiogenic hepatocyte growth factor (HGF) and anti-apoptotic, pro-myogenic insulin-like growth factor 1 (IGF-1) encapsulated in Alginate-Sulfate nanoparticles (AlgS-NP) improves left ventricular (LV) functional recovery in a porcine ischemia-reperfusion (I/R) model.

Methods

Myocardial infarction (MI) was induced by 75min balloon occlusion of the mid-LAD followed by reperfusion. After 1w, pigs (n=12) with marked LV dysfunction (EF<45%) were randomized to fusion imaging-guided IM injections of 8 mg Cy5-labelled AlgS-NP loaded with 200μg HGF and IGF-1 (GF) or with phosphate-buffered saline (CON) using the MYOSTAR injection catheter. AlgS-NP retention in the heart was determined by measuring Cy5 levels in peripheral blood. At 8w, treatment effect was evaluated using cardiac magnetic resonance imaging and coronary flow reserve (CFR) measurements, and further assessed using sirius red staining to measure myocardial fibrosis.

Results

At 1w after MI, LV ejection frqction (LVEF) was 37±5% (range 27–45%) and infarct size (IS)/LV mass 24±6% (range 19–38%). Myocardial retention of AlgS-NP was comparable between 2 groups (maximal systemic leakage after IM injection: 9% CON vs 20% GF, P=0.25). After 8 w, IS/LV mass decreased by one third in GF-treated pigs compared with 14% in CON (P=0.03, Fig. A) and was associated with a trend towards improvement in CFR (P=0.05, Fig. B). LVEF significantly increased in GF-treated pigs (6±2% vs. −1±1%, P=0.02, Fig. C), which was attributable to a greater reduction in end-systolic volume. The improvement in LVEF was also consistent with significant reduction of fibrosis (P=0.01, Fig. D) in the peri-infarct zone (PI).

Conclusions

Intramyocardial injection of AlgS-nanoparticle-encapsulated HGF and IGF-1 to the ischemic myocardium significantly improves LV repair, and offers the prospect of innovative treatment for patients with refractory ischemic heart disease.

Funding Acknowledgement

Type of funding source: Public grant(s) – EU funding. Main funding source(s): EuroNanoMed, Horizon 2020
PETCO2 gradient: a novel prognostic parameter in cardiopulmonary exercise testing
Authors: Poveda Pinedo I.D , Marco Clement I , Gonzalez O , Ponz I , Iniesta A.M , Pena L , Rodriguez M.J , Hernandez M.D , Arranz H , Araujo A , Marin M , Espinosa S , Dalmau R , Castro A , Lopez Sendon J.L
Published: November 2020

Background

Previous parameters such as peak VO2, VE/VCO2 slope and OUES have been described to be prognostic in heart failure (HF). The aim of this study was to identify further prognostic factors of cardiopulmonary exercise testing (CPET) in HF patients.

Methods

A retrospective analysis of HF patients who underwent CPET from January to November 2019 in a single centre was performed. PETCO2 gradient was defined by the difference between final PETCO2 and baseline PETCO2. HF events were defined as decompensated HF requiring hospital admission or IV diuretics, or decompensated HF resulting in death.

Results

A total of 64 HF patients were assessed by CPET, HF events occurred in 8 (12.5%) patients. Baseline characteristics are shown in table 1. Patients having HF events had a negative PETCO2 gradient while patients not having events showed a positive PETCO2 gradient (−1.5 [IQR −4.8, 2.3] vs 3 [IQR 1, 5] mmHg; p=0.004). A multivariate Cox proportional-hazards regression analysis revealed that PETCO2 gradient was an independent predictor of HF events (HR 0.74, 95% CI [0.61–0.89]; p=0.002). Kaplan-Meier curves showed a significantly higher incidence of HF events in patients having negative gradients, p=0.002 (figure 1).

Conclusion

PETCO2 gradient was demonstrated to be a prognostic parameter of CPET in HF patients in our study. Patients having negative gradients had worse outcomes by having more HF events.

Time to first event, decompensated heart

Funding Acknowledgement

Type of funding source: None
His-bundle pacing in CHF-patients with narrow QRS and chronic AF – an upgrade from single-chamber to dual-chamber ICD
Authors: Ciesielski A , Slawuta A , Zabek A , Boczar K , Malecka B , Hiczkiewicz J , Gajek J
Published: November 2020

A single-chamber ICD is a standard method for primary SCD prophylaxis. In patients with chronic atrial fibrillation it does not contribute to the regularization of heart rate, which is crucial for proper treatment. Moreover, to avoid the deleterious effect of right ventricular pacing only minority of the patients with single chamber ICD get the appropriate, recommended dose of beta-blockers.

The aim of our study was to assess the efficacy of direct His-bundle pacing in a population of patients with congestive heart failure and chronic atrial fibrillation using upgrade from single chamber to dual-chamber ICD and atrial channel to perform the His-bundle pacing

Methods

The study population included 39 patients (37 men, 2 women) aged 67.2±9.3 years, with CHF and chronic AF implanted primarily with single chamber ICD with established pharmacotherapy and stable clinical status.

Results

The echocardiography measurements at baseline and during follow-up were presented in the table:

During short period (3–6 months) of follow-up the mean values of EF and LV dimensions significantly improved. This was also accompanied by functional status improvement.

Conclusions

His-bundle-based pacing in CHF-chronic AF patients contributes to significant echocardiographic and clinical improvement. Standard single-chamber ICD implantation in CHF-chronic AF patients yields only SCD prevention without influence on remodeling process. The physiological pacing contributes to better pharmacotherapy.

Funding Acknowledgement

Type of funding source: None
LIVE procedure for ischemic heart failure: the evolution of an unique technique
Authors: Neves P , Pillay T , Van Bladel K , Annest L
Published: November 2020

Background

Ischemic cardiomyopathy is the leading cause of heart failure. In patients with left ventricular (LV) dilatation, low ejection fraction, and transmural scar in an anteroseptal distribution, surgical ventricular reconstruction (SVR) is a treatment option. However, SVR is an invasive procedure which often cannot be offered to patients with ischemic cardiomyopathy due to other comorbidities. Less Invasive Ventricular Enhancement (LIVE) technique is a unique intervention to exclude scarred myocardium, improving symptoms and quality of life.

Methods

LIVE procedure has evolved from open sternotomy to a hybrid procedure done with right internal jugular vein access and a left minithoracotomy. LV shape and size is restored without extracorporeal circulation by plication of the scarred myocardium. This is achieved by implantation of a series of internal and external microanchors brought together over a poly-ether-ether-ketone (PEEK) tether to make a longitudinal approximation between the LV free wall and the anterior septum. Internal anchors are deployed by a transcatheter technique, through the right internal jugular vein, on the right side of the ventricular septum.

Results

Between July 2018 and January 2020, 47 patients (84.4% men; mean age 61±12.5 years) were submitted to the LIVE procedure in 16 Institutions in Europe, North America and Asia. Procedural success was 100%. There was no intra-hospital mortality. A mean of 2.3 anchor pairs (median 2) were used to reshape the LV. Echocardiographic data showed an increase in LV ejection fraction (EF) from 31.4±9.2% to 40.0±12.4% (change +29.8%, p<0.001) and LV end-systolic volume index (LVESVI) reduction from 66.6±29.3 ml/m2 to 40.7±21.5 ml/m2 (change −38%, p<0.001) and LV end-diastolic volume index (LVEDVI) reduction from 92.8±39.2 ml/m2 to 60.6±25.9 ml/m2 (change −33.2%, p=0.001) after the procedure. Sternotomy conversion was needed in one patient due to right ventricular perforation. New onset tricuspid valve regurgitation was observed in one patient. There was no case of ventricular septal defect. In the mean follow-up period of 9.8 months, NYHA class improved a median of 1 grade and there was no late mortality.

Conclusion

Hybrid LV reshaping and volume reduction has proven to be a useful option for patients with symptomatic heart failure after left anterior descending territory myocardial infarction. These results from the latest iteration of the technique show that this approach is safe and has a significant short and mid-term impact on improving EF and reduction in LV.

LIVE procedure

Funding Acknowledgement

Type of funding source: None
Neuromuscular comorbidity, atrial fibrillation and left bundle branch block predict the prognosis of left ventricular hypertrabeculation/noncompaction
Authors: Stoellberger C , Hasun M , Winkler-Dworak M , Finsterer J
Published: November 2020

Background

The prognosis of patients with left ventricular hypertrabeculation/noncompaction (LVHT) is controversially assessed. LVHT is frequently associated with neuromuscular disorders (NMDs). Aim of the study was to assess cardiac and neurological findings as predictors of mortality in LVHT-patients.

Methods

Included were patients with LVHT diagnosed between June 1995 and December 2019 in one echocardiographic laboratory. They underwent a baseline cardiologic examination and were invited for a neurological investigation. In January 2020, their survival status was assessed.

Results

LVHT was diagnosed in 310 patients (93 female, aged 53±18 years) with a prevalence of 0.4%/year. A neurologic investigation was performed in 205 patients (67%). A specific NMD was found in 33 of the investigated patients (16%), NMDs of unknown etiology in 123 (60%) and the neurological investigation was normal in 49 (24%) patients. During 86 months of follow-up, 59 patients received implanted electronic devices (cardioverter/defibrillator n=21, antibradycardic pacemakers n=11, cardiac resynchronization device/defibrillator n=22, cardiac resynchronization device n=4). During follow-up 105 patients died and 6 patients underwent heart transplantation. The mortality was 4.7%/year. By multivariate analysis, the following baseline parameters were identified as predictors of mortality: increased age (p=0.0005), inpatient-status when LVHT was diagnosed (p=0.0050), presence of a specific NMD (p=0.0187) or NMD of unknown etiology (p=0.0052), atrial fibrillation (p=0.0007) and left bundle branch block (p=0.0168).

Conclusions

LVHT patients should be systematically investigated neurologically since neurological comorbidity has a prognostic impact. Electrocardiographic abnormalities like atrial fibrillation and left bundle branch block should be considered when planning pharmacotherapy and device-therapy. It has to be assessed by prospective studies, which measures improve the prognosis of LVHT.

Funding Acknowledgement

Type of funding source: None
Prediction of serum NGAL levels using comorbidity AHEAD score and two-year prognosis in stable chronic heart failure patients (FAR NHL registry)
Authors: Labr K , Spinar J , Parenica J , Spinarova L , Malek F , Spinarova M , Ludka O , Jarkovsky J , Benesova K , Pavkova Goldbergova M , Labrova R
Published: November 2020

Background

Neutrophil gelatinase-associated lipocalin (NGAL) is marker of renal function and is strongly associated with presence of comorbidities. AHEAD comorbidity score is commonly used to predict survival in acute heart failure patients and could predict events even in chronic heart failure.

Methods

547 stable patients with chronic heart failure patients with left ventricular ejection fraction <50% were included in FARmacology and NeuroHumoraL activation (FAR NHL) registry. Three cardiological centres from The Czech Republic with speciality in heart failure were participating.

Results

Median age was 66 years, 80.3% were men. The etiology of heart failure was in 54% ischemic heart disease, in 40% dilatated cardiomyopathy, in 0.5% hypertrophic cardiomyopathy. 60% of patients were in NYHA class II.

In the first two years of follow-up, 74 events (13.5%) occurred, including all-cause death, left ventricle assist device implantation or orthotopic heart transplantation.

The AHEAD comorbidity score (Atrial fibrillation, low Haemoglobin level <120 g/L in female or <130 g/L in male, Elderly >70 years; Abnormal renal parameters with creatinine >130 μmol/L, Diabetes mellitus; 1 point for each comorbidity present) was set in this registry. Patients with AHEAD 0–1 survived without event in 89.2%, AHEAD 2–3 in 82.4% and AHEAD 4–5 only in 63.5% (p<0.001; pairwise comparison 0.034, <0.001, 0.021).

Also levels of NGAL are higher when comorbidities from AHEAD score are present: Atrial fibrillation (62 vs. 50 ng/mL; p<0.001), Haemoglobin level (Spearman's rank correlation coefficient −0.240; p<0.001), Eldery (Spearman's coefficient 0.425; p<0.001), Abnormal creatinine level (Spearman's coefficient 0.528; p<0.001), Diabetes mellitus (57 vs. 51 ng/mL; p=0.006).

NGAL levels are singificantly higher in patients with higher AHEAD score. Mean level of NGAL in AHEAD 0–1 (N=320) is 51 ng/mL, in AHEAD 2–3 (N=190) is 78 ng/mL and in AHEAD 4–5 (N=37) is 142 ng/mL (Kruskal-Wallis test p<0.001, pairwise comparision all <0.001).

Conclusion

In stable chronic heart failure registry FAR NHL, comorbidity score AHEAD can predict events. Serum NGAL level is significantly higher when AHEAD score comorbidities are present: Atrial fibrillation, low Haemoglobin, Eldery, Abnormal renal function and Diabetes mellitus.

Funding Acknowledgement

Type of funding source: None
Hypercapnic ventilatory response in heart failure patients with central sleep-disordered breathing
Authors: Roder F , Potratz M , Sohns C , Rudolph V , Fox H
Published: November 2020

Background

Sleep-disordered breathing (SDB) is a highly common comorbidity in heart failure (HF) patients and appears mainly as obstructive SDB, or central SDB. SDB has been shown to deteriorate quality of life in HF patients, but its presence is also associated with worse prognosis. SDB severity has been shown to mirror HF level and hereby hypercapnic ventilatory response (HCVR) depicts ventilation instability which furthermore expresses HF severity. But HCVR direct correlation with HF to predict HF severity has not been sufficiently studied yet.

Methods and results

We included 501 HF patients that received multichannel cardiorespiratory polygraphy, clinical workup for HF and HCVR in our center. The degree of SDB was graded with apnea-hypopnea-index (AHI) with guideline recommendation for treatment at an AHI >15/h. NT-Pro-BNP was obtained for HF quantification.

Mean age was 66.4±11 years, body mass index (BMI) 30.7±5 kg/m2 and mean HCVR was 2.56±1.18. 136 (27.2%) patients had central SDB with a proportion of 124 (24.8%) having moderate to severe SDB (AHI >15/h). 345 (68.9%) had obstructive SDB with moderate to severe SDB in 296 (59.1%) patients. Differences were detected for HCVR and HF in the central SDB group with a HCVR of 2.78±1.4 and NT-Pro-BNP of 2835.88±10536.4 pg/ml, while the OSA group shows a HCVR of 2.5±1 and NT-Pro-BNP of 929.9±1781.

Linear regression identified HCVR (p=0.045) and NT-Pro-BNP (p=0.034) to independently correlate with central SDB and in addition HCVR was also significantly associated with NT-Pro-BNP (p=0.007).

Conclusion

HF severity is closely linked to both NT-Pro-BNP and central SDB. HCVR seems to have the potential to predict manifestation of central SDB and increased NT-Pro-BNP values in HF. HCVR may be an easily obtainable parameter to identify both HF severity and presence of central SDB in HF patients.

Funding Acknowledgement

Type of funding source: None
Rheumatoid arthritis significantly increases incidence of heart failure: examination of an underestimated co-morbidity
Authors: Khalid Y , Dasu N.R , Khalid F.A
Published: November 2020

Background

The association between coronary heart disease and autoimmune inflammatory conditions such as rheumatoid arthritis has been well established and studied. We aim to elucidate another very important, but overlooked co-morbidity: heart failure.

Purpose

To evaluate the increased incidence of both systolic and diastolic heart failure in patients who have co-morbid rheumatoid arthritis, compared to the general population. We hypothesize that patients with inflammatory diseases such as rheumatoid arthritis will have significantly increased incidence of heart failure which will require earlier screening and prevention in this patient population.

Methods

This study is based on a systematic review of published literature utilizing MEDLINE, EMBASE and PUBMED that investigated the association between rheumatoid arthritis and congestive heart failure. Our study included 5,220,960 patients. We also performed a meta-regression analysis to evaluate the effect of age on incidence of heart failure. Summary relative risk (RR) and 95% confidence intervals (CI) were estimated using a random-effects model.

Results

In 5,220,960 patients, the incidence of heart failure was 2-fold higher in patients with rheumatoid arthritis compared to a matched control population (OR 1.835, 95% CI 1.77–1.90, p<0.00001). On meta-regression, when plotting log odds ratio of incidence of heart failure (y-axis) against age (x-axis), incidence increased further with older age (coefficient = 0.344, p=0.0001). Women were also found to have 5-fold higher incidence of heart failure with rheumatoid arthritis.

Conclusion

For patients with rheumatoid arthritis, there was a markedly higher incidence of heart failure compared to a matched patient population without rheumatoid arthritis. Meta-regression showed a trend towards increased incidence of heart failure with increased age that reached statistical significance. Women were also at a drastically higher risk of heart failure if they had rheumatoid arthritis.

Funding Acknowledgement

Type of funding source: None
Impact of comorbidity on the predictive value of cystatin-C in patients admitted for acute decompensated heart failure: insights from a prospective study
Authors: Kayama K , Yamada T , Watanabe T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Kawahira M , Fukunami M
Published: November 2020

Background

Comorbidities are strongly associated with poor clinical outcome in heart failure patients. The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure patients. On the other hand, Cystatin C, as a novel and important biomarker of renal function, has been recently reported as a useful long-term risk stratification score in heart failure patients. However, there is no information available on the impact of comorbidities on the prognostic value of cystatin-C in patients admitted for acute decompensated heart failure (ADHF).

Methods

We prospectively studied 458 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Echocardiography and venous blood sampling were performed just before discharge and serum cystatin-C level was measured. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). ACCI was commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD).

Results

During a follow-up period of 2.8±1.5 years, 132 patients had ACD. At multivariate Cox analysis, ACCI (p=0.0015) and cystatin-C level (p=0.0145) were significantly and independently associated with ACD. Patients with high ACCI (≥6: determined by ROC analysis) had a significantly greater risk of ACD (37.2% vs 17.8%, p<0.0001, HR 2.45 [1.61–3.70]). In the subgroup of higher ACCI, patients with higher cystatin-C level (≥1.56: determined by ROC analysis) had a significantly higher risk of ACD (50.3% vs 23.4%). Furthermore, in the subgroup of lower ACCI, patients with higher cystatin-C level had also significantly higher risk of ACD (34.2% vs 12.1%).

Conclusions

The prognostic value of cystatin-C is not affected by comorbidities and cystatin-C provide prognostic information even in patients admitted for ADHF, irrespective of comorbid burden.

All-cause death-free rate in ADHF pts

Funding Acknowledgement

Type of funding source: None
Independent predictors of heart failure in patients with type 2 diabetes and chronic kidney disease: modeling from the CREDENCE trial
Authors: Mahaffey K.W , Li J , Chang T.I , Sarraju A , Agarwal R , Charytan D.M , Greene T , Heerspink H.J.L , Levin A , Neal B , Pollock C , Yavin Y , Jardine M , Perkovic V , Cannon C.P
Published: November 2020

Background

SGLT2 inhibitors have been shown to reduce hospitalization for heart failure (HHF). We sought to determine independent baseline predictors for HHF specifically in a population with type 2 diabetes and chronic kidney disease (CKD).

Methods

CREDENCE randomized 4401 participants with type 2 diabetes and CKD to canagliflozin 100 mg versus placebo. We evaluated the baseline clinical and demographic factors using multivariate regression modeling to identify the independent predictors of HHF.

Results

Overall, 230 participants (89 canagliflozin; 141 placebo) had at least 1 HHF event. Canagliflozin reduced the incidence of HHF compared with placebo (4.0% vs 6.4%; HR 0.61; 95% CI 0.47–0.80). Participants with HHF events postrandomization were older (65.8 vs 62.9 y), and had a longer duration of diabetes (17.4 vs 15.7 y), higher prevalence of prior HF (30.4% vs 14.0%), higher urinary albumin:creatinine ratio (1347 vs 904 mg/g), lower estimated glomerular filtration rate (51.5 vs 56.4 mL/min/1.73m2), and higher prevalence of prior cardiovascular disease (65.7% vs 49.6%) compared to those without HHF. Independent predictors of HHF are shown in the Table.

Conclusions

HHF is common in patients with type 2 diabetes and CKD. Canagliflozin reduces HHF by 39% compared with placebo. Higher urinary albumin:creatinine ratio was the most potent predictor of HHF and should be part of patient risk assessment.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Janssen Research & Development, LLC
Impact of hospital volume on in-hospital mortality and 30-day cardiac readmission of hospitalized patients with heart faliure. A population based study
Authors: Bonilla Palomas J.L , Anguita-Sanchez M.P , Elola F.J , Bernal J.L , Fernandez-Perez C , Ruiz-Ortiz M , Jimenez-Navarro M , Bueno H , Cequier A , Marin F
Published: November 2020

Background

Heart failure (HF) is a major health care problem. Epidemiological data from hospitalized patients are scarce and the association between hospital volume and patient outcomes is largely unknown.

Purpose

The aim of this study was to analyze the relationship between hospital volume and outcomes (in-hospital mortality and 30-day cardiac readmission).

Methods

We conducted an observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We calculated risk-standardized mortality rates (RSMR) at the index episode and risk-standardized cardiac diseases readmissions rates (RSRR) within 30 days after discharge by using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Information on the number of HF discharges at each hospital in 2015 was analysed to classify centres into 2 categories (high- and low-volume hospitals). To discriminate between high- and low-volume centers, a K-means clustering algorithm was used. The association between volume and RSMR or RSRR was tested with the Pearson correlation coefficient and linear regression models.

Results

A total of 117 233 episodes of HF were selected during 2015. The mean age was 80±10 years and 46% were women. The crude in-hospital mortality rate was 12.1% and 30-day cardiac readmission rate was 18%. The cut-off point was set at 517 HF discharges per hospital during 2015. High volume hospitals had a statistically lower RSMR (10.3±2.8 vs 11.3±3.6; p<0.001) and higher RSRR (10.7±1.9 vs 9.2±1.6; p<0.001) than low volume hospitals. Low-volume hospitals showed higher dispersion of outcomes than high-volume, both for RSMR and RSRR (Figure).

Conclusions

We found that patients hospitalized for HF in 2105 had lower in-hospital mortality if they were admitted to a high-volume hospital. We have also found that high-volume hospitals had higher 30-day cardiac readmission rates.

Funding Acknowledgement

Type of funding source: None
Trends in hospitalization and in-hospital mortality of patients with heart failure in Spain. A population-based study (2003–2015)
Authors: Bonilla Palomas J.L , Anguita-Sanchez M.P , Elola F.J , Bernal J.L , Fernandez-Perez C , Ruiz-Ortiz M , Jimenez-Navarro M , Bueno H , Cequier A , Marin F
Published: November 2020

Background

Heart failure (HF) is one of the most pressing current public health concerns. However, in Spain there is a lack of population data.

Purpose

To investigate trends in HF hospitalization and in-hospital mortality rates.

Methods

We conducted a retrospective observational study of patients discharged with the principal diagnosis of HF from The National Health System' acute hospitals during 2003–2015. The source of the data was the Minimum Basic Data Set of the Ministry of Health, Consumer and Social Welfare. We analyzed trends in hospital discharge rates for HF (discharge rates were weighted by age and gender) an in-hospital mortality. The risk-standardized in-hospital mortality ratio (RSMR) was defined as the ratio between predicted mortality (which individually considers the performance of the hospital where the patient is attended) and expected mortality (which considers a standard performance according to the average of all hospitals) multiplied by the crude rate of mortality. RSMR was calculated using a risk adjustment multilevel logistic regression models developed by the Medicare and Medicaid Services. Temporal trend during the observed period was modelled using Poisson regression analysis with year as the only independent variable. In this model, the incidence rate ratio (IRR) and their 95% confidence intervals (95% CI) was calculated.

Results

A total of 1 254 830 episodes of HF were selected. Throughout 2003–2015 the number of hospital discharges with principal diagnosis of HF increased by 61% (IRR: 1.04; CI: 1.03–1.04; p<0.001), meanwhile the crude mortality rate and the mean length of stay (LOS) diminished significantly (IRR: 0.99; CI: 0.98–1; and IRR: 1.04; CI: 0.99–0.99; p<0.001, for both). Discharge rates weighted by age and sex showed a statistically significant increase during the period (IRR: 1.03; CI: 1.03–1.03; p<0.001); however, whereas discharge rates increased significantly in older groups of age (≥75 years old) (IRR: 1–1.02; p<0.001) they diminished in younger groups of age (45–74 years old) (IRR: 0.99; p<0.001 and there was not a significant trend in the discharge rates for the group of 35–44 years old (Figure). The risk-standardized in-hospital mortality ratio did not significantly change throughout 2003–2015 (IRR: 0.997; CI: 0.992–1; p=0.32), however the risk-standardized LOS ratio diminished from 1.07 in 2003 to 0.97 in 2015 (IRR: 0.98: IC: 0.98–0.99; p<0.001).

Conclusions

From 2003 to 2015, HF admission rate increased significantly in Spain as a consequence of the sustained increase of hospitalization in the population over 75. The crude in-hospital mortality rate diminished significantly for the same period, but the risk-standardized in-hospital mortality ratio did not significantly change.

Figure 1

Funding Acknowledgement

Type of funding source: None
Strauss formula: a great and easy tool to manage congestion in acute heart failure
Authors: Martinho A , Almeida J , Campos G , Rosa J , Ferreira C , Freitas A , Ferreira J , Milner J , Alves P , Baptista R , Franco F , Goncalves L
Published: November 2020

Background

Approaching the congestive patient is a complex task that requires the combination of different assessment methods. The Strauss formula uses variations in haemoglobin and haematocrit to estimate plasma volume variations (PVV) and haemoconcentration. However, this formula was only validated in outpatients followed with chronic heart failure. We aimed to assess the applicability of this formula to hospitalized patients for acute heart failure (AHF).

Methods

We conducted a single-centre, retrospective, observational study of 302 patients who were admitted to our hospital for AHF during 2016 and were discharged alive. Baseline clinical, laboratory and demographic characteristics were evaluated at admission and the Strauss formula was applied, as PVV (%) = 100 x [(Hb A / Hb D) x (1 − Hct D) / (1 − Hct A)] − 100), where A = admission and D = discharge. At discharge, we considered that a positive change (≥0%) in PV regarding the admission was linked to an increase in PV (haemodilution); a negative change (<0%) correlated to a decrease in the PV (haemoconcentration). The primary endpoint was a composite of cardiovascular death (CV-death) and HF readmission at 3-months.

Results

Mean age was 76±11 years and 57% were male. At baseline, 92% were on clinical-haemodynamic profile B, with a median NT-proBNP of 2157 (IQR 1161–4242) pg/dL, a mean of glomerular filtration rate (GFR) of 63±57 mL/min/m2, a mean haemoglobin of 12±2 g/dL and a mean haematocrit of 38±6%. At discharge, the median plasma volume variation was −1.1% (IQR – 9.6 to 7.8) and the distribution of PVV values in the histogram reveals that a large proportion of patients (44%) increased or maintained plasma volume (PVV ≥0% – haemodilution). The group of patients who decreased plasma volume at discharge was slightly younger (75 vs 78 years, p=0.044), showing higher numerical decreases in NT-proBNP, gamma-glutamyl transferase (gGT) and bilirubin at discharge. A positive change in PV (PVV >0%) during admission almost doubled the risk for readmission and CV-death at 3-months [OR 1.9 (95% CI: 1.1 to 3.1, p=0.026], after adjusting for age and sex.

Conclusions

In this work, we demonstrate that PVV, as calculated by the Strauss formula, increases or is unchanged in 44% of patients admitted with AHF and is strongly associated with a composite of 3-months CV death and HF readmission. Tools to guide the management of residual congestion are of great importance to assess the optimal discharge timing.

Funding Acknowledgement

Type of funding source: None
Long-term serial changes of cardiac sympathetic nerve dysfunction in acute decompensated heart failure patients with reduced, mid-range and preserved left ventricular ejection fraction
Authors: Seo M , Yamada T , Watanabe T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Fukunami M
Published: November 2020

Background

Cardiac sympathetic nerve dysfunction, which is assessed by I-123 metaiodobenzylguanidine (MIBG) imaging, is associated with the poor outcomes in patients with chronic heart failure (CHF). Serial evaluation of cardiac MIBG imaging was shown to be useful for predicting adverse outcome in CHF. However, there was no information available on long-term serial changes of cardiac sympathetic nerve dysfunction after discharge of acute decompensated heart failure (ADHF) hospitalization.

Purpose

We aimed to clarify the serial change of cardiac MIBG imaging parameter in long-term after discharge of heart failure hospitalization, especially relating to HFrEF (LVEF<40%), HFmrEF (40%≤LVEF<50%) and HFpEF (LVEF≥50%).

Methods

We studied 112 patients (HFrEF; n=44, HFmrEF; n=23 and HFpEF; n=45) who were admitted for ADHF, discharged with survival and without heart failure hospitalization during follow-up period. All patients underwent cardiac MIBG imaging at the timing of discharge, in 6–12 months and in 18–24 months after discharge. The cardiac MIBG heart to mediastinum ratio (H/M) was calculated on the early image and the delayed image (late H/M). The cardiac MIBG washout rate (WR) was calculated from the early and delayed planar images after taking radioactive decay of I-123 into consideration.

Results

In HFrEF patients, late H/M was significantly improved from discharge to 6–12 months data (1.60±0.24 vs 1.75±0.31, p<0.0001). Late H/M of HFmrEF patients was also significantly improved from discharge to 18–24 months data (1.71±0.27 vs 1.84±0.29 p=0.043). On the other hand, late H/M of HFpEF patients was not significantly changed. As for WR, WR in HFrEF and HFmrEF patients was significantly improved from discharge to 18–24 months data, although WR of HFpEF was not significantly changed.

Conclusion

The improvement in cardiac sympathetic nerve dysfunction was observed in patients with HFrEF and HFmrEF, not in HFpEF, after the discharge of acute heart failure hospitalization.

Funding Acknowledgement

Type of funding source: None
The impact of stem cell therapy in chronic ischaemic heart disease and congestive heart failure: an updated cochrane systematic review and meta-analysis of randomised controlled trials
Authors: Weeraman D , Hadyanto S , Jones D , Mathur A
Published: November 2020

Introduction

Controversies in stem cell research (Anversa retractions) have led many to question the validity of clinical cell therapy research. There is however consistent data supporting the use of cell therapy for chronic IHD.

Purpose

To update the clinical evidence for the safety and efficacy of autologous adult bone marrow-derived stem/progenitor cells as a treatment for chronic IHD and CHF.

Methods

A full Cochrane review of relevant trials up to 21st November 2018 was performed. Randomised controlled trials comparing autologous adult stem/progenitor cells with no cells in participants with chronic IHD and CHF were deemed eligible. Trials that involved acute myocardial infarction were excluded.

Results

In total 41 randomised controlled trials and 2397 patients are included in the meta-analysis. This updated Cochrane review shows a statistically significant reduction in mortality (RR 0.51; 95% CI, 0.37 to 0.68; p≤0.00001) and MACE (RR 0.66; CI 0.55 to 0.80; p<0.00001) seen with cell therapy. This is associated with a significant improvement in symptoms (exercise tolerance, NYHA, CCS) and ejection fraction.

Conclusions

Cell therapy may be effective for this patient group both for cardiovascular outcomes and symptom control. This conclusion therefore warrants further testing of cell therapy in prospective clinical trials assessing meaningful clinical endpoints.

Stem cell therapy and risk of all-cause

Funding Acknowledgement

Type of funding source: None
The developing mechanism of atherosclerotic lesion in coronary side branch on the ventricular free wall differs by the location of lesion
Authors: Yamanaka Y , Fujimori Y , Hashimoto S , Kurihara K , Wakabayashi T , Imai T , Baba T , Takeuchi W , Yokota D
Published: November 2020

Background

The effective treating method of coronary side branch lesions such as ostial stenosis or thin arteries has not been established. On the other hand, tortuous side branch rarely has stenotic lesions.

Purpose

We focused on coronary side branches on the ventricular free wall, and examined coronary risk factors and bending and stretching motion of branch which can contribute to the development of atherosclerotic lesion.

Methods

In elective and first-time coronary angiograms, we included side branches on the ventricular free wall (>2mm in diameter) and excluded previously treated ones. Study A; we divided arteries into proximal, middle, and distal segment, and examined the presence of tortuosity and stenotic lesions exceeding 50% diameter stenosis (DS) for each segment. A score of 1 was assigned to tortuous segment, and 0 to non-tortuous one. Study B; we included stenotic lesion (>50% DS) in side branch ostium and excluded those extended across main coronary arteries. Relation between lesions and patients' characteristics was examined.

Results

Study A; in 1,828 side branches from 472 patients, middle and distal segments had significantly higher tortuosity score than proximal (0.68, 0.78 vs. 0.34; p<0.0001). On the contrary, proximal segments had more stenotic lesions except ostial stenosis (230 vs. 69, 5; p<0.0001). Study B; in 1,740 side branches from 465 patients, 122 ostial stenotic lesions were found (7.0%). Multivariate logistic regression analysis revealed diabetes mellitus and age as independent contributors to development of ostial stenosis (Table).

Conclusions

Side branch stenosis developed less frequently in middle and distal segments, where stronger ventricular wall motion reinforces bending and stretching motion and tortuosity of arteries. This fact indicates that those characteristics may prevent developing atherosclerosis through increasing shear stress. On the other hand, diabetes mellitus strongly contributes to the development of ostial stenosis. Thus, the developing mechanism of atherosclerotic lesion in side branch on the ventricular free wall differs by the location of lesion.

Funding Acknowledgement

Type of funding source: None