bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparable risk of ischemic stroke in patients with screen-detected atrial fibrillation on single timepoint handheld ECG screening to patients with known AF
Authors: Sun W , Freedman B , Martinez C , Wallenhorst C , Yan B.P.Y 
Published: November 2020

Abstract

Aims
To determine risk of ischemic stroke in patients with single timepoint screen-detected atrial fibrillation (AF).

Methods
Cohort of 11,972 consecutive patients aged ≥65 years attending medical outpatient clinics in Hong Kong underwent AF screening using a handheld single-lead ECG (AliveCor) from Dec 2014 to Dec 2017 (NCT02409654). Repeated screening was performed in patients who had &gt;1 clinic visit during the study period. Cohort was divided into 4 exposure groups: (i) new AF detected by initial screening (S1-AF); (ii) new AF detected by subsequent screening or clinically diagnosed during follow up (FU-AF); (iii) known AF and (iv) no initial or subsequent FU-AF (no AF). Exposure in the FU-AF group was handled as a time-dependent variable. All AF exposure groups were further stratified by oral anticoagulant (OAC) use at the end of FU. Cumulative incidence of ischemic stroke was compared between groups during a median FU period of 2.3 (IQR=1.7–3.3) years, using Fine and Gray regression accounting for death as competing risk and using no AF as reference.

Results
Of 11,972 subjects enrolled, 2,236 (18.7%) had known AF and 9,736 (81.3%) underwent 13,571 screening events during the study period. The yield of newly diagnosed AF on initial screening was 2.3% (n=223/9,736), with 71 new AF detected by subsequent screening. During FU, 2.3% (221/9,442) screen-negative patients were diagnosed with AF clinically. Compared to no AF, S1-AF without OAC had the highest ischemic stroke risk (subdistribution hazard ratio (SHR)=2.79; 1.47–5.27), then FU-AF without OAC (SHR=2.66; 1.21–5.82) and known AF without OAC (SHR=1.97; 1.50–2.57). All AF groups taking OAC had similar risk of ischemic stroke as no AF.

Conclusion
This is the first study to report the prognosis of AF detected by single timepoint screening. The prognosis is not benign. Both risks of stroke and benefits from anticoagulation therapy were similar between screen-detected and known AF.

Funding Acknowledgement
Type of funding source: None
Acute response to cardiac re-synchronization therapy: ventricular properties adaptation?
Authors: Degiovanni A , Gravellone M , Erbetta R , Dell' Era G , Marino P.N , Patti G 
Published: November 2020

Abstract

Background
Cardiac re-synchronization therapy (CRT) reduces mortality and hospitalization in patients with heart failure, reduced left ventricular ejection fraction (LVEF) and left bundle branch block (LBBB). However, there is no conclusive evidence on baseline parameters able to discriminate responder vs non-responder patients.

Purpose
In this study, we tested whether echocardiographic parameters describing LV dyssynchrony and efficiency may predict an acute LV recovery after CRT and whether lead position can modify such relationship.

Methods
We enrolled 65 consecutive patients (75% males, aged 71.2±10.5 years) referred for CRT according to current guidelines; 45% had an underlying ischaemic cardiopathy and 1/3 of them presented diabetes mellitus. We performed a CRT-off and CRT–on 2D and 3D echocardiography during devices optimization (time between programming change 10/12 min). We evaluated ventricular dyssynchrony by speckle-tracking analysis based on temporary uniformity of strain (TUS) 3D longitudinal and circumferential. We also derived non-invasive myocardial efficiency (Effic) by interaction between pressure work index (PWI), representing an estimation of myocardial oxygen consumption, and mechanical external work. We indicated as concordant those patients presenting a LV lead position (defined from a chest X-ray using 2 orthogonal views) in the same segment as the latest systolic 3D circumferential strain curves.

Results
In the CRT-on phase, a non-statistically significant raise in LVEF was observed [from 0.37 (0.28–0.46) to 0.41 (0.34–0.47), p=0.27]. No improvement in both longitudinal and circumferential 3D TUS was demonstrated during CRT-on (p=0.44 and 0.47, respectively). Conversely, the gain in Effic from CRT-off to CRT-on phase was overall significant (from 0.43±0.14 to 0.50±0.16; p&lt;0.001). After switching to CRT-on, the increase in longitudinal 3D TUS was higher in concordant compared to discordant patients (from 0.83±0.08 to 0.87±0.07 vs 0.88±0.11 to 0.87±0.12, respectively), but without significant interaction (interaction p 0.24). No interaction was also found between variations of PWI after switching to CRT-on and LV lead position (concordant: from 12.99±4.18 to 12.84±2.99 ml/min/100g; discordant: from 13.58±3.89 to 13.95±3.97 ml/min/100g; interaction p 0.75).

Conclusions
Effic was overall acutely augmented during CRT-on phase in patients with LV dysfunction undergoing cardiac re-synchronization. In the acute phase, no significant relationship between LV changes in speckle-tracking analyses after CRT and LV lead position was found.
2-way ANOVA for myocardial efficiency

Funding Acknowledgement
Type of funding source: None
Endoscopic repair of atrial functional mitral regurgitation in heart failure: long-term effects
Authors: Balogh Z , Mizukami T , Bartunek J , Collet C , Beles M , Albano M , Katbeh A , Casselman F , Vanderheyden M , Van Camp G , Van Praet F , Penicka M 
Published: November 2020

Abstract

Introduction
In patients with heart failure and preserved ejection fraction (HFpEF), even mild atrial functional mitral regurgitation (AFMR) has been associated with poor outcome.

Objective
To describe long-term effects of endoscopic mitral valve (MV) repair on outcome in patients with HFpEF and AFMR.

Methods
The study population consisted of consecutive patients with HFpEF (LVEF ≥50%, H2FPEF score ≥5) and AFMR, who underwent isolated, minimally invasive (endoscopic), MV repair (MVRepair group) (n=131) or remained on standard of care (StanCare group) (n=139). Patients with coronary artery disease or organic MR were excluded. Patients were matched using inverse probability of treatment weighting. Primary objective was all-cause mortality or HFpEF readmissions.

Results
The median follow up was 5.03 years (IQR 2.6–7.9 years). In the MVRepair group, the perioperative, 30-day, 1- and 5-year mortality was 0, 1% and 12%, respectively. Additional 13 (10%) patients were readmitted for worsening HFpEF, while 2 (1%) individuals underwent redo MV surgery for recurrent MR. MVRepair compared with StanCare showed 21–29% (SE 6–8%) and 19–26% (SE 6–8%) absolute risk reduction of all-cause mortality and HFpEF readmissions, respectively (all p&lt;0.05). MVRepair emerged as the strongest independent predictor of all-cause mortality (HR 0.16, 95% CI 0.07–0.34, p&lt;0.001) and HFpEF readmissions (HR 0.21, 95% CI 0.09–0.51, p&lt;0.001). At 5-year follow-up, in the MVRepair group, a total of 88% were alive and 80% were alive without readmission for HFpEF.

Conclusions
Endoscopic MV repair is associated with low perioperative mortality, high long-term efficacy and appears to improve clinical outcome in patients with AFMR and HFpEF.
Mortality and readmission for HF

Funding Acknowledgement
Type of funding source: None
Copeptin, albumin and routine inflammatory markers are predictors of one-year mortality in patients with advanced heart failure underwent cardiac transplantation evaluation
Authors: Szygula Jurkiewicz B , Szczurek W , Skrzypek M , Romuk E , Gasior M 
Published: November 2020

Abstract

Introduction
Despite significant advances in the prevention and treatment of heart failure (HF), the prognosis for patients with advanced stage of the disease is still poor. Therefore, a better understanding of the underlying HF pathophysiological mechanisms is crucial to improve prognosis in patients with advanced HF. One important research area is the role of inflammation in the pathophysiology of HF.

Purpose
This study aimed to investigate factors associated with mortality in HF patients with particular emphasis placed on inflammatory markers.

Methods
This is a prospective analysis of 282 optimally treated HF patients hospitalised in Cardiology Department between 2016 and 2018 for heart transplantation (HT) evaluation. Patients with contraindications to HT were excluded from the study. At the baseline echocardiography, routine laboratory tests, an ergospirometric exercise test, and right heart catheterisation were performed in all patients. In addition, 10 ml of peripheral blood was collected to determine inflammatory biomarkers. Human procalcitonin and copeptin concentrations were measured by the sandwich enzyme-linked immunosorbent assay (ELISA) with the commercially available kit. A highly sensitive latex-based immunoassay was used to detect plasma C-reactive protein (CRP) using the COBAS Integra 70 analyzer. The end-point of the study was all-cause mortality during one-year follow-up. The study protocol was approved by the Local Ethics Committee of our medical university. All patients provided informed, voluntary consent to participate in the study.

Results
The median age of patients was 57 (51–60) and 87.6% of them were male. A total of 79 (28%) patients died during a one-year follow-up. Multivariate analysis of the Cox proportional hazard model confirmed that procalcitonin [hazard ratio (HR) 1.003 (1.002–1.003), p&lt;0.001], high sensitivity C-reactive protein (CRP) [HR 1.109 (1.039–1.183), p&lt;0.002], copeptin [HR 1.109 (1.019–1.207), p&lt;0.02] and albumin [HR 0.925 (0.873–0.979), p&lt;0.01] serum concentrations, as well as Erythrocyte Sedimentation Rate (ESR) [HR 1.031 (1.001–1.063) p&lt;0.05] were associated with mortality during a one-year follow-up.

Conclusions
Our study demonstrated that higher procalcitonin, CRP and copeptin serum concentrations as well as higher ESR and lower albumin serum concentrations are independently associated with reduced survival in patients with advanced HF.

Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): Medical University of Silesia
Donation after circulatory death hearts recipients compared to donation after brain death heart recipients have comparable systolic left ventricular function and better myocardial strain at 1 year
Authors: Ciarka A , Page A , Messer S , Pavlushkov E , Tsui S , Parameshwar J , Williams L , Aggraval B , Large S 
Published: November 2020

Abstract

Purpose
Cardiac transplantation from donation after circulatory death (DCD) has been implemented at our hospital since February 2015. Despite encouraging results some concerns may be raised about the impact of the warm ischemia and reperfusion injury on the myocardium status at longer follow-up. Therefore, we aimed to analyse systolic performance of the left ventricle at 1 year follow in DCD and donation after brain death (DBD) cardiac recipients, as assessed by echocardiography with myocardial deformation imaging.

Methods
We identified 46 consecutive DCD cardiac recipients who were transplanted from February 2015 to August 2018 and we matched them with 46 DBD cardiac recipients. Six and 7 patients from DCD and DBD group, respectively, died in the first-year post transplant. In the remaining patients we have compared the classical echocardiographic measurements as well as global longitudinal strain (GLS) and global circumferential strain (GCS) at 1-year follow-up.

Results
DCD and DBD patients did not present with differences in terms of classical echocardiographic parameters of left ventricular (LV) structure and systolic function at one-year follow-up. LVEDV was similar in DCD and DBD patients (101±24 vs. 95±32 ml, p=0.4 respectively), as well as LVESV (42±13 vs. 42±16 ml, p=0.9, respectively), LV ejection fraction (58±6 vs. 56±8%, p=0.22) and LV mass (156±39 vs. 163±38 gr, p=0.2, respectively). In contrast, myocardial deformation parameters, such as GLS and GCS, were better in DCD than in DBD (16.1 vs. −14.5%, p&lt;0.01; and −25.2 vs. 22.3%, p&lt;0.05, respectively). The diastolic LV function parameters were similar in DCD and DBD group, as evidenced by E wave velocity, A wave velocity and deceleration time of mitral inflow, however E over E prime was lower in DCD than in DBD recipients (7.7±8.7, p&lt;0.05). Fractional area change of the right ventricle was higher in DCD in comparison with DBD (46±7 vs. 40±7%, p&lt;0.01) while right atrial volume index was lower in DCD than in DBD (25±8 vs. 29±9 ml/m2, p&lt;0.01). Other parameters of RV function (systolic excursion of the tricuspid annulus, TAPSE) were similar in both groups.

Conclusion
DCD and DBD heart recipients present with similar systolic LV function at 1-year follow, as assessed by classical echocardiographic parameters. DCD cardiac recipients have better myocardial deformation parameters as assessed by the speckle tracking, better systolic right ventricular function and lower filling pressures of the left ventricle.

Funding Acknowledgement
Type of funding source: None
Early ECMO overcomes primary graft dysfunction after heart transplant
Authors: Gkouziouta A , Miliopoulos D , Miliopoulos D , Dimopoulos S , Dimopoulos S , Karabinis A , Bonios M , Stavridis S , Karabinis A , Stavridis S , Adamopoulos S , Kogerakis N , Adamopoulos S , Kogerakis N 
Published: November 2020

Abstract

Introduction
Primary graft dysfunction (PGD) is the main cause of early mortality after heart transplantation. Despite affecting approximately 7–8% of all recipients, the etiology and optimal treatment of this condition remains unknown. Extracorporeal membrane oxygenation (ECMO) is a key treatment modality, however optimal timing of initiation has not been established.

Methods
A single-institution retrospective study was conducted. Between January 2003 and October 2019 a total of 13 recipients experienced PGD treated with ECMO. At the beginning of 2016, our institution adopted an early ECMO policy, with PGD patients placed on ECMO prior to leaving the OR at the time of transplant. Patients were stratified into pre-2016 (n=5) and post-2016 (n=8) cohorts. Outcomes including duration of support, ICU and total hospital stay, Ejection Fraction (EF), need for vasoactive or inotropic medication, in-hospital survival, 1-year survival, and complications were analyzed.

Results
Among the pre-2016 and post-2016 cohorts there was no difference in duration of ECMO, ICU stay, and total hospital stay. The average time from release of cross-clamp to initiation of ECMO was 8.04 vs 3.05 hrs in each cohort, respectively (p=0.02). In all patients, ECMO resulted in a reduction in the need for vasopressors and inotropes as assessed by the vasoactive inotrope score. LVEF normalized within the first 5 days of therapy for all patients and was sustained after decannulation. Complication rates among cohorts were similar with respect to bleeding, stroke, infection, and need for permanent dialysis. When compared to the post-2016 cohort, the pre-2016 cohort demonstrated significantly worse in-hospital (75% vs 100%, p=0.04) and 1-year (69% vs 100%, p=0.02) survival.

Conclusions
Early initiation of ECMO results in decreased mortality for PGD after heart transplant without an increased risk of complications.

Funding Acknowledgement
Type of funding source: None
Age-related difference of longitudinal associations of early/late cardiac systolic load with decline of preserved cardiac systolic function in Japanese men
Authors: Kumai K , Hirofumi H.T , Chikamori T.C , Yamashina A.Y 
Published: November 2020

Abstract

This prospective observational study was conducted to examine the longitudinal associations of early/late cardiac systolic load (ESL/LSL) with decline of preserved cardiac systolic function, and also to examine the age-related differences in their associations. In 3679 middle-aged Japanese healthy men (43±9 years), brachial-ankle pulse wave velocity (baPWV) which related to ESL, radial augmentation index (rAI) which related to LSL and pre-ejection period/ejection time (PEP/ET) were measured annually during a 9-year study period. In subjects aged &lt;50 years old (n=2586), baPWV, rAI and PEP/ET were annually increased. The PEP/ET at both the start and end of study period were significantly increased from low to high tertile ranges of baPWV and also of rAI at the start of study period (Figure). In subjects aged &gt;50 years old (n=1093), baPWV and PEP/ET, but not rAI, were annually increased. Then, the PEP/ET at both the start and end of study period were increased among the tertile ranges of baPWV but not in those of rAI (Figure). In the mixed model linear regression analysis, while the baPWV (estimate = 7.2x10–5, p&lt;0.01) and rAI (estimate = 60.0x10–5, p&lt;0.01) were longitudinally associated with the PEP/ET in subjects under 50 years of age, only baPWV had a significant longitudinal association with PEP/ET (estimate = 8.4x10–5, p&lt;0.01) in subjects aged &gt;50 years old. Thus, in Japanese healthy men, age-related differences in the progression of vascular functional abnormalities may result in a difference in their effect on the decline of preserved cardiac systolic function. Namely, while age-related increase in ESL related with arterial stiffness may decrease preserved cardiac systolic function in subjects of all ages, age-related increase in LSL related with pressure wave reflection may decrease this parameter only in subjects under 50 years of age.
Figure 1

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Omron Health Care, Asahi Calpis Wellness
Trends in outcome and patient composition in dilated cardiomyopathy in Sweden over time
Authors: Sjoland H , Silverdal J , Bollano E , Pivodic A , Fu M 
Published: November 2020

Abstract

Background
We studied prognosis and patient composition over time in dilated cardiomyopathy (DCM): a well-defined category of heart failure (HF), often affecting younger individuals. We expected improved prognosis over time, due to emerging diagnostic and therapeutic options.

Methods
All patients from the Swedish Heart Failure Registry (SwedeHF) fulfilling criteria for DCM (exclusion of ischemic, valvular, or alcoholic etiology and affirmed by clinical judgment in the protocol) (n=3739), were analyzed with respect to three time periods of inclusion in the registry, 2003–2007 (n=814), 2008–2011 (n=1448), 2012–2016 (n=1477), regarding mortality, transplantations, and hospital admissions during one year after inclusion.

Results
Over the three time periods, registered cohorts were older with time (mean 59.3 years/ 60 years/ 61.0 years, p=0.0035), and the proportion of females incresased (24.1% / 27.2% / 30.7%, p=0.0006).
For clinical variables, the distribution of left ventricular ejection fraction (LVEF) with time showed significantly higher LVEF (p=0.0024), and functional classification (NYHA) showed lower class (p=0.0011). Hypertension as a comorbidity (i.e. not judged to be responsible for HF) was more frequently occurring with time: (34.0%/ 40.6%/ 44.1%, p&lt;0.0001). As for HF treatment: use of device increased (p&lt;0.0001 for categorical combinations), mineralocorticoid receptor antagonists (MRA) increased (41.9%/ 37.3%/ 46.7%, p=0.0023), and diuretics dropped (76.1%/ 71.1%/ 67.0%, p≤0.0001) in the different cohorts with time.
Mortality (6.9%, 5.1%, 5.5%), transplantation (0.5%, 0.8%, 0.6%) and hospital admissions for HF (28.4%, 26.3%, 24.6%) were stable over time (ns for all), whereas cardiovascular (CV) (33.8%, 33.8%, 29.7%, p=0.043) and all cause admissions (39.1%, 38.8%, 33.7%, p=0.0099) decreased. After adjustment for age, sex, LVEF, NYHA, hypertension and device treatment only all cause admissions remained significantly decreased.

Conclusion
In this nationwide study between 2003–2016, one-year outcome in DCM in Sweden remained stationary over time, despite advances in HF therapy. During the time period, we observed a continuous change in the clinical profile in the DCM population.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Region Västra Götaland agreement concerning research and education of physicians.
The nationwide registry of hospitalized heart failure patients in Japan: Japanese Registry Of Acute Decompensated Heart Failure (JROADHF)
Authors: Ide T , Kaku H , Matsushima S , Tohyama T.I , Enzan N , Funakoshi K , Sumita Y , Nakai M , Nishimura K , Fukuda H , Hatano M , Komuro I , Tsutsui H 
Published: November 2020

Abstract

Background and aim
Heart failure (HF) is a growing healthcare problem worldwide. This study aimed to describe clinical characteristics and long-term outcomes of HF patients in Japan.

Methods and results
JROADHF (the Japanese Registry Of Acute Decompensated Heart Failure) is a retrospective, multicentre, nationwide observational database of 13,238 patients hospitalized due to HF in 128 hospitals randomly selected from Japanese Circulation Society (JCS)-certified teaching hospitals during 2013. At inclusion, demographic and clinical data were collected from medical records with linkage to a nationwide claim-based database, the Japanese Diagnosis Procedure Combination (DPC). Patients were followed up to 5 years after discharge at each participating site. Patients were old as the median age of 81 years and women were older (74.8±12.8 vs 81.6±11.1 y.o). Mean left ventricular ejection fraction (LVEF) was 47%, and 45% were HF with preserved ejection fraction of &gt;50% (HFpEF). Causes of HF included ischemic in 27%, valvular in 19%, arrhythmia in 17%, and hypertensive in 16%. Median length of hospital stay was 18 days and in-hospital mortality was 7.7%. All-cause mortality during 1 and 4 years were 22.3% and 48.4%, respectively. Hospitalization rates due to HF within 1 and 4 years were as high as 30.5 and 48.4%, respectively.

Conclusions
Contemporary nationwide registry revealed that hospitalized HF patients were elder and had more HFpEF, and their prognosis was still poor compared to the data shown in prior registries.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development (AMED) Practical Research Project for Life-Style related Diseases including Cardiovascular Diseases and Diabetes Mellitus