bluuebunny/crossref_metadata_2025_split huggingface dataset:
P6313RAAS inhibition improves event-free survival in cardiac transplant recipients: results of the prospective cohort study
Authors: Shevchenko A , Gautier S , Shevchenko O , Kachanova J , Kwan V 
Published: October 2019

Abstract

Background
Despite known achievements, long-term survival of heart transplant (HT) recipients still needs to be improved. The Renin-Angiotensin-Aldosterone System (RAAS) hyper-activation could be the result of heart denervation and immune suppressive therapy in these patients. Angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) have been shown to be beneficial in patients with hypertension, heart failure (HF) and diabetic nephropathy.

Purpose
The study was aimed to assess the effects of ACEI and ARB on the prognosis and cardiac transplant remodelling in HT recipients.

Methods
Four hundred ninety-six critical HF patients had cardiac transplant surgery between January 2012 and December 2016 in Shumakov National Research Centre of Transplantology, and Artificial Organs (Moscow, Russian Federation) which accounted to 57.9% of all heart transplantations (HTx) performed in the country during that period. All patients >18 years old who survived 30 days after the operation without known contraindications for ACEI or ARB were sequentially included in the study. A non-randomised controlled trial study design was used. Study endpoints included death from any cause and re-transplantation due to the irreversible cardiac transplant failure.

Results
385 HT recipients (mean age 46.3±2.3 years, 51 females and 334 males) enrolled in the study. Thirty days after the HTx, a RAAS inhibitor was assigned to 141 recipients. Patients receiving ACEI or ARB had significantly better event-free survival than the control group (log-rank p=0.045) during the follow-up for 1856.5±68.3 days. Unadjusted analysis revealed other factors related to the risk of death or irreversible HT failure: recipient age <37 years old, donor age>44 years old, aortic cross-clamping time >117 min, peri-operational ECMO>3 days of duration, acute renal failure requiring dialysis during first 30 days after the operation, right atrium size, mitral regurgitation 2+, tricuspid regurgitation 1+, donor's heart posterior wall thickness (PWT) >12mm, and left ventricle (LV) end-diastolic dimension (EDD). When adjusted to the RAAS inhibitors use, only the donor's age and early renal failure remained significant. LV EDD did not change over time in both groups, whereas LV PWT in the control group significantly increased from 12.3±0.3 to 13.5±0.5 mm (p<0.05).

Conclusions
Heart transplant recipients who received RAAS inhibitors had better survival and less LV hypertrophy progression that could reflect the beneficial effects of ACEI and ARB after heart transplantation.
P6317Recipient or donor age in heart transplantation:which one fits more?
Authors: Di Nora C , Lechiancole A , Ferrara V , Sponga S , Tursi V , Guzzi G , Nalli C , Livi U 
Published: October 2019

Abstract
Increasing recipient (RA) and donor age (DA) are independently associated with mortality after Heart Transplantation (HT). The aim of this study was to analyse the impact of age-matching on HT survival. 485 recipients who underwent HT between 1990 and 2018 in our Institution were divided into four groups: RA<60-DA<50 (Group 1), RA<60-DA>50 (Group 2), RA>60-DA<50 (Group 3), RA>60-DA>50 (Group 4), and their outcomes were compared. Emergency HT, bridge with MCS and re-HT were excluded. Mean follow-up was 109±84 months.
The survival of Group 1 patients was significantly higher than that of patients in other groups (p=0.001). The outcome of young recipients who received older donor grafts did not significantly differ from that of older recipients. At multivariate analysis, donor age, recipient age, Diabetes Mellitus and hypercholesterolemia correlated with long-term mortality.
Demographic variables 1 (d/r) 2 (r/D) 3 (R/d) 4 (D/R) P Value Recipients data   No. of patients 241 61 107 76 –   Female, n (%) 50 (21) 16 (26) 17 (16) 11 (14) 0.25   Age (years), mean ± sd 49±10 54±7 64±3 65±3 <0.001*   Creatinine (mg/dl), mean ± sd 1.3±0.8 1.5±0.5 1.4±0.4 1.5±0.5 0.49   Diabetes Mellitus, n (%) 33 (14) 17 (28) 38 (36) 30 (39) <0.001*   Hb (g/dl), mean ± sd 12.9±2.4 11.5±2 13±1.7 12±2 0.08   Tot. Bilirubin (mg/dl), mean ± sd 1.3±1 1±0.6 1.2±0.8 1.1±0.7 0.63   sPAP (mmHg), mean ± sd 42.4±14.2 47.5±15.9 44.6±14.8 49.6±16.2 0.07 Etiology 0.003*   Ischemic, n (%) 74 (30) 25 (41) 55 (51) 40 (53)   Dilative, n (%) 110 (46) 24 (39) 40 (37) 29 (38)   Valvular, n (%) 19 (8) 5 (8) 5 (5) 5 (6) Donors and Surgical data   Age, (years) mean ± sd 31±10.5 56.5±4 36±10.5 57.5±4.5 <0.001*   Female sex, n (%) 73 (30) 30 (49) 38 (35) 33 (43) 0.02*   LVEF, mean ± sd 58±4 56±5 60±9 63±9 0.73   Graft ischemia time (min), mean ± sd 198±63 205±62 209±64 193±69 0.75   ECC time (min), mean ± sd 218±72 213±64 214±70 192±53 0.45

In this study, the use of hearts from older donors did not affect survival of older recipients; conversely, in young recipients it increased the risk of mortality.
P6322Trajectories of functional limitations during 14 months after discharge among patients with heart failure: a multicenter cohort study
Authors: Adachi T , Iwatsu K , Kamisaka K , Iida Y , Yamada S 
Published: October 2019

Abstract

Background
Severity of functional limitations (FLs) has been considered as a prognostic factor in patients with heart failure (HF). However, trajectory patterns of FLs after discharge and their associated factors have remained unclear.

Purpose
This study aimed to explore trajectories of FLs after discharge and to examine clinical characteristics based on the identified trajectories.

Methods
This study was performed as a part of a multicenter cohort study. The cohort study enrolled hospitalized patients due to acute HF or exacerbation of chronic HF and who were able to walk at discharge. Patients with severe cognitive or psychological disorders or less than 6-month life expectancy were excluded. FLs were assessed using Performance Measure for Activities of Daily Living-8 (PMADL-8; higher scores indicate worse FLs) at discharge and 1-, 6-, 10- and 14-month after discharge. To identify FLs trajectories getting worse after discharge, we excluded patients already having severe FLs at discharge (PMADL-8 ≥21, a cut off value for predicting poor prognosis). Group-based trajectory modeling (GBTM) was conducted to identify distinct PMADL-8 trajectories. Then, associated factors of trajectory group that showed increasing FLs after discharge were examined using logistic regression analysis adjusted for potential confounders.

Results
A total of 953 patients were included in the analysis (age: 70.6±11.8 years, men: 70.9%, left ventricular ejection fraction <40%: 41.3%). GBTM identified four PMADL-8 trajectories: two separate trajectories where PMADL-8 remained low (T1: 14.1%, T2: 31.3%), mildly increasing PMADL-8 trajectory (T3: 41.0%) and rapidly increasing PMADL-8 trajectory (T4: 13.6%) (Figure). Logistic regression analysis showed that age (odds ratio 1.05, per 1 year; 95% confidence interval 1.02–1.07), women (2.12; 1.31–3.45), brain natriuretic peptide ≥200 pg/mL (1.88; 1.10–3.21), estimated glomerular filtration rate <30 mL/min/1.73m2 (2.50; 1.41–4.41), depression (2.34; 1.44–3.80), and re-hospitalization due to HF during 1-year follow-up (2.85; 1.56–5.21) were independent associated factors of T4 group.
Figure 1. Trajectories of PMADL-8

Conclusions
The high-risk population for increasing FLs after discharge was identified by GBTM. The findings of this study suggest the importance of long-term HF management for preventing FLs after discharge especially among those with older age, female gender and depression.

Acknowledgement/Funding
This work was supported by a Grant-in-Aid for Scientific Research (A) from the Japan Society for the Promotion of Science [16H01862].
P6325Gas exchange improvements during exercise correlate with hemodynamic changes in heart failure patients with a left ventricular assist device
Authors: Seuthe K , Morosin M , Smail H , Gerhardt F , Simon A , Dumitrescu D 
Published: October 2019

Abstract

Background
The implantation of left ventricular assist devices (LVAD) has established its role in therapy for patients with end stage heart failure.
Benefits in survival as well as an improved quality of life, compared to optimized medical therapy (OMT) alone, has been proven.
There are limited data in the literature on the metabolic changes during exercise in LVAD patients, and in most studies no increase in peak oxygen consumption on cardiopulmonary exercise test (CPET) could be shown early after surgery. However, recent data suggests an improvement in peak oxygen uptake (VO2) as a late effect after rehabilitation.
To further investigate these findings we sought to analyse CPET data from patients before LVAD implantation as well as in the early and late follow up in correlation with hemodynamic changes at these times.

Methods
We collected and retrospectively analysed data of heart failure patients who had undergone LVAD implantation, and in whom a right heart catheterization, a cardiopulmonary exercise test and an echocardiography had been performed at time before, as well as 6 Months and 12 months after LVAD implantation, respectively.

Results
Data of 43 patients implanted with an LVAD between 2011 and 2017 were analysed. There was significant improvement in cardiac output (3,2 vs 4,3 L/min, p<0,001) and VE/VCO2 slope (46 vs 38, p=0,001) 6 months after LVAD implant as well as a significant reduction in PCWP (26 vs 11 mmHg, p<0,001), PAP mean (40 vs 22 mmHg, p<0,001), RA mean (12 vs 8 mmHg, p=0,002) and PVR (4,2 vs 2,5 WU, p<0,001). However, there was no significant increase in peak VO2 after 6 months.
12 months after LVAD implantation there were no further significant changes in cardiac output, intracardiac pressures or VE/VCO2 slope, which all remained similar to the 6 months follow up. However, at that point, a significant increase in peak VO2 was seen, compared to baseline (1060 vs 1410ml/min, p=0,001) and to 6 months after surgery (Figure 1).

Conclusion
Cardiac output increases in heart failure patients early after LVAD implantation. Consequently, permanent ventricular off loading results in the reduction of intracardiac pressures and improvement in the VE/VCO2 slope 6 months after surgery. However, a significant rise in peak oxygen consumption could only be noted 12 months after surgery, suggesting either a delayed long-term effect of improved hemodynamics or other causes such as enhanced mobility or training due to improved quality of life.
P6326Which results of the cardiopulmonary exercise test deserve greatest attention to establish the prognosis in heart failure?
Authors: Gama F , Freitas P , Ferreira A , Durazzo A , Aguiar C , Tralhao A , Ventosa A , Ferreira J , Mendes M 
Published: October 2019

Abstract

Background and aim
Limitation of exercise tolerance is one of the cardinal manifestations of heart failure (HF). Cardiopulmonary exercise testing (CPET) provides a thorough assessment of exercise integrative physiology involving the pulmonary, muscular, and oxidative cellular systems. We aimed to identify which data collected during a CPET shows the best prognostic performance with respect to predicting mortality or the need for heart transplantation (HT).

Methods
Single-centre retrospective cohort study of consecutive HF patients performing a CPET for functional and prognostic HF evaluation from October 1996 till May 2018. Left ventricular ejection fraction was not an exclusion criterion. A Cox model was fit with time to death or heart transplantation (whichever recorded first within 5 years) as the dependent variable and CPET parameters as the independent variables. Both unadjusted and adjusted covariate Cox regressions were performed. ROC curve analysis was used to determine whether the significant variables, as a model, could reliably predict the study endpoint.

Results
The study population consisted of 513 patients, median age 58 (IQ 16) years, and 74.9% male. The majority had reduced ejection fraction (75.4%), and the most common HF aetiology was ischemic heart disease (55.8%). During the 5-years follow up, 126 patients died and 60 underwent heart transplantation. In unadjusted Cox regression, nearly all CPET variables were significantly associated with the study endpoint. After covariate adjustment, with prior exclusion of redundant variables, three measures remained associated with the study endpoint: peak VO2 consumption (hazard ratio [HR] 0.85; 95% confidence interval [CI], 0.81–0.90); VE/VCO2 slope (HR 1.02; 95% CI, 1.00–1.02); presence of oscillatory ventilatory pattern (HR 3.73; 95% CI, 2.43–5.72). As a model, these 3 variables showed a strong discriminatory ability (c-statistic 0.87; 95% CI, 0.83–0.90) (see figure) for the study endpoint.
Figure 1

Conclusion
When using the CPET for prognostic stratification of HF patients, the presence of an oscillatory ventilatory pattern, the peak VO2 and the VE/VCO2 slope are the most important tools on which clinicians should focus.
P6330Obesity paradox in heart failure with mid-range ejection fraction
Authors: Zamora E , Lupon J , De Antonio M , Domingo M , Moliner P , Santiago-Vacas E , Santesmases J , Boldo M , Diez-Quevedo C , Troya M I , Rivas C , Gonzalez B , Diaz V , Velayos P , Bayes-Genis A 
Published: October 2019

Abstract

Background
Obesity is identified as an independent risk factor for developing congestive heart failure (HF). Paradoxically it has been reported that obesity is associated with improved survival in different cohorts of HF patients. Nevertheless, the presence of obesity paradox in HF with mid-range ejection fraction (HFmrEF) is not completely elucidated.

Objective
To analyse the relationship between body mass index (BMI) and mortality in a HFmrEF ambulatory cohort of different aetiologies followed in a HF unit, with especial focus on the role of obesity in prognosis.

Methods
Baseline BMI was analysed as continuous variable and categorized in 4 groups based on 2009 WHO classification: low weight (BMI <20.5 kg/m2), normal weight (BMI 20.5 to <25.5 kg/m2), overweight (BMI 25.5 to <30 kg/m2) and obesity (BMI ≥30 kg/m2). All-cause mortality was the primary end-point of the study. Cox regression analyses adjusted by age, sex and NYHA functional class were performed and survival curves plotted.

Results
Three-hundred thirty patients were included in the study (age 65.9±13.2 years, 68% men). The main aetiology was ischemic heart disease (52%, followed by dilated cardiomyopathy (11%) and hypertensive cardiomyopathy (11%). The majority of patients were in NYHA class II (65%) and III (26%). Mean ejection fraction was 43.2% ± 2.7. During a mean follow-up of 5.3±4.6 years 142 patients (42%) died. BMI showed a protective effect on survival in Cox regression analysis (HR 0.96 [95% CI 0.92–0.99], p=0.01). When categorized groups of BMI were analysed, obese patients showed a trend towards lower mortality than normal weight patients (reference): adjusted HR 0.65 [95% CI 0.40–1.03], p=0.07. Survival curves adjusted by age, sex and NYHA functional class according to BMI category are depicted in the figure. As a significant interaction (p=0.02) was found between BMI and ischemic aetiology of HF, separate analyses were performed for BMI categories for ischemic and non-ischemic patients, with remarkably different results: ischemic aetiology: HR 0.97 [95% CI 0.52–1.79], p=0.91; non-ischemic aetiology HR 0.28 [95% CI 0.13–0.64], p=0.003.

Conclusions
A greater BMI was associated with lower mortality rates in patients with HFmrEF during a mean follow-up of five years. Obesity showed a protective effect in HFmrEF patients, which remarkable in patients from non-ischemic aetiology and was absent in patients from ischemic aetiology.
P6351A point-of-care risk score predicts 30-day readmission in patients hospitalized with heart failure (HF): derivation and validation of the LENT index
Authors: Van Spall H G C , Lee S F , Averbuch T , Erbas Oz U , Perez R , Ko D T , Connolly S J 
Published: October 2019

Abstract

Background
Risk prediction models in heart failure (HF) are typically complex, derived retrospectively from administrative databases, and modest in their ability to discriminate between high, medium, and low risk categories. The complexity of these models makes them difficult to use at the point of care.

Purpose
To determine if a simple risk index using Length of hospital stay (L), number of Emergency department visits in the preceding 6 months (E), and either admission or discharge N-Terminal (NT) prohormone of Brain Natriuretic Peptide (pro-BNP) at the point of care can predict 30-day readmissions in patients hospitalized for HF.

Methods
This is a sub-study of the Patient-Centered Care Transitions in HF (PACT-HF) stepped-wedge cluster randomized trial. We included 772 patients hospitalized for HF at 10 Canadian hospitals. We used log-binomial regression models with Length of stay, Emergency department visits in the preceding 6 months, and either admission or discharge N-Terminal prohormone of Brain Natriuretic Peptide (NT-pro-BNP) as the predictor variables and 30-day all-cause readmission as the outcome. We derived the LENT risk score from the β-coefficients of the regression model (Fig. 1). All the models were adjusted for post-discharge services. We assessed model discrimination with C-statistics and model calibration with the net reclassification index (NRI). We used the bootstrapping approach with 100 runs for internal validation.

Results
The LENT index had a possible score ranging from 1 to 13 (Fig 1). Increments in the LENT risk score were associated with an increased risk of 30-day readmission; a 1-point increase in the LENT index using the admission and discharge NT-pro-BNP predicted a 23% and 19% increase in 30-day readmission risk, respectively. The internal validation produced similar results. Compared to a null model, the LE index had an NRI of 0.35 [95% CI 0.18, 0.53], and admission and discharge NT-pro-BNP further improved calibration of the LE index (NRI 0.15 [95% CI 0, 0.32] and 0.20 [95% CI 0.03, 0.37], respectively). The LENT index offered modest discrimination for 30-day readmission (C-statistic 0.64 [95% CI 0.59, 0.69]), similar to more complex risk models.
Figure 1. The LENT index scoring system

Conclusion
A simple risk index based on Length of stay, Emergent visits, and NT-pro-BNP at the point of care can reliably predict 30-day readmissions. The LENT index offers ease of use over traditional risk prediction models.

Acknowledgement/Funding
Canadian Institutes of Health Research, Ontario MOHLTC, Roche Diagnostics
P6358Novel biomarkers for prediction of acute cardiorenal syndrome
Authors: Dankova M , Minarikova Z , Danko J , Gergel J , Pontuch P , Goncalvesova E 
Published: October 2019

Abstract

Objectives
Acute kidney injury (AKI) is frequent event in patients with acute heart failure (AHF) and is associated with poor short and longterm outcome. Aim of the study was to decribe diagnostic yield of selected novel biomarkers in prediction of AKI in patients addmitted for AHF.

Methods
We performed a prospective cohort study of 72 consecutive patients (46/26 M/F) aged 69±10,3 years admitted for AHF. Renal damage was defined according to KDIGO guidelines. Patients were divided into two groups: AKI- (without renal injury, n=52) and AKI+ (with renal injury, n=20). Urine samples for AKI biomarkers measurements (NGAL, TIMP2, IGFBP7) were collected at admission. The ROC and linear logistic regression of new biomarkers and selected clinical variables was performed for evaluation of the AKI prediction.

Results
Patients with AKI + were older (median age: 75 vs. 64 years, p=0,01), had lower BMI (median: 28 vs. 29,5 kg/m2, p=0,04), were with higher proportion of patients with HF with reduced ejection fraction (55% vs 23,1%, p=0,01) and higher level of serum NTproBNP. Urinary NGAL at admission was significantly higher in the AKI+ compared to AKI – group (152 vs. 19,5 ng/ml, p <.0001); also median of u-TIMP-2 and u-IGFBP-7 in the AKI+ patients were significantly higher: 194,1 versus 42,5 ng/ml (p<0.0001) and 379 versus 92,4 pg/ml (p<0.0001) resp. Age, u-NGAL, u-TIMP2, u-IGFBP7, s-hemoglobin, NTproBNP and LVEF were associated with the development of AKI. Urine concentration IGFBP-7 performs the best for the prediction AKI (AUC 0,94).

Conclusion
Urine concentrations of NGAL, TIMP2, IGFBP7 at the time of admission for AHF predict developement of AKI. Age, NTproBNP, LVEF and s-hemoglobin are also associated with AKI in AHF patients.

Acknowledgement/Funding
Project was supported by Slovak Society of Cardiology research grant 2015-2018.
P6364Challenges of implementation of new European Guidelines 2018 on hypertension in a real clinical practice
Authors: Alieva A S , Konradi A O , Kurapeev D I 
Published: October 2019

Abstract

Objective
Novel European guidelines 2018 on Hypertension raised the question about the implementation of new target blood pressure (BP) levels into real practice. The aim of the present study was to compare achieved target BP levels in clinical practice according to European guidelines 2013 and 2018.

Design and methods
Data of 25428 hypertensive patients form the electronic data base of ambulatory of the Research Centre during 2016–2018 years were analyzed. 8484 hypertensive patients were examined in 2016, 8490 patients – in 2017 and 8454 patients – in 2018 year. Only patients with hypertension as the major disease and on current medication were and under the age of 80 years included.

Results
Applying the Guidelines 2013, 5978 patients (23,5%) were on target and have had BP control under 140/90 mm Hg, while according to new Guidelines 2018 only 1749 patients (6,9%) have achieved recommended BP level under 130/80 mm Hg.
BP control according to both Guidelines Year Sex Age group Number of hypertensive patients BP <140/90 mm Hg BP <130/80 mm Hg 2016 Women Under 50 716 208 (29%) 72 (10,1%) Women 50 and older 4894 1197 (24,5%) 344 (7,0%) Men Under 50 997 252 (25,3%) 57 (5,7%) Men 50 and older 1877 402 (21,4%) 104 (5,5%) 2017 Women Under 50 716 201 (28,1%) 66 (9,2%) Women 50 and older 4734 1049 (22,2%) 325 (6,9%) Men Under 50 1156 266 (23%) 59 (5,1%) Men 50 and older 1884 339 (18%) 84 (4,5%) 2018 Women Under 50 744 224 (30,1%) 87 (11,7%) Women 50 and older 4544 1126 (24,8%) 360 (7,9%) Men Under 50 1364 312 (22,8%) 80 (5,9%) Men 50 and older 1802 402 (22,3%) 111 (6,2%)

Conclusion
According to the previous criteria approximately quarter of all hypertensive patients in real clinical practice in St.Petersburg are on target, while recommended in 2018 Guidelines new target levels are achieved less that in 12%t. Women under 50 have a better BP control. It seems that implementation of new targets for BP will be extremely hard and needs huge investment in education, motivation, compliance and new strategies.