bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors of relapse after improved ejection fraction in patients with heart failure
Authors: Esteves A.F , Marinheiro R , Fonseca M , Farinha J.M , Pinheiro A , Ferreira J , Goncalves S , Duarte T , Fonseca N , Caria R 
Published: November 2020

Abstract

Background
Patients with systolic dysfunction with improvement in left ventricular ejection fraction (LVEF) present a more favorable clinical profile when compared to those that maintain dysfunction. However, little is known about the characteristics of patients who “relapse” after LVEF improvement.

Purpose
Evaluate prevalence, clinical characteristics and outcomes of patients in whom ejection fraction declined after previous improvement.

Methods
We retrospectively studied patients followed at a heart failure (HF) clinic with LVEF improvement after an initial diagnosis of HF with reduced ejection fraction (EF), which was defined as having an LVEF &gt;40% on follow-up. We then evaluated the presence of LVEF “relapse” in these patients – a decline in LVEF to &lt;50% or &lt;40%, in cases where it recovered to preserved EF or to mid-range EF, respectively. We analysed patient demographics, clinical parameters and outcomes and used logistic regression to assess the predictors of LVEF “relapse”.

Results
98 patients were studied, 70 (71%) male, median age 69 (58–76) years.
Fifty-four (55%) patients had recovered EF (&gt;50%) and in 44 (45%) it had improved to mid-range values. In 36 (37%) occurred LVEF “relapse”: in 10 (10%) patients to an EF 40–50% and in 88 (90%) to an EF&lt;40%.
Ischemic cardiomyopathy and non-ischemic dilated cardiomyopathy were the main HF aetiologies (38% and 35%, respectively).
During a median follow-up of 7 years, 39 (40%) patients had at least one HF hospitalization. Global mortality was 30%, with no significant statistical difference between the two groups.
In univariate analysis, HF duration, type 2 diabetes mellitus (T2DM), left main or left anterior descending coronary (LAD) disease, valvular heart disease (VHD) and chronic kidney disease (CKD) predicted LVEF “relapse”.
In multivariate analysis, T2DM, left main or LAD disease and VHD were the only predictors of LVEF “relapse” (Table).

Conclusion
In this group of patients, LVEF “relapse” after it had initially improved was frequent and was predicted by the presence of T2DM, left main or LAD disease and VHD. Despite improved systolic function, these patients remain at high risk, thus the need to maintain treatment.

Funding Acknowledgement
Type of funding source: None
Impact of right ventricular contractile reserve on exercise capacity in patients with heart failure: clinical application of low-load exercise stress echocardiography
Authors: Kinoshita M , Inoue K , Akazawa Y , Nakagawa H , Sasaki Y , Higashi H , Fujii A , Uetani T , Aono J , Nagai T , Nishimura K , Ikeda S , Yamaguchi O 
Published: November 2020

Abstract

Background
The peak oxygen uptake (VO2) evaluated by the cardiopulmonary exercise test (CPX) is an established marker of exercise capacity in patients with heart failure (HF). In particular, peak VO2 &lt;14 ml/kg/min is used to be one of the criteria for heart transplantation. However, given exercise intolerance in patients with HF, it is difficult for refractory HF patients to reach sufficient exercise load. A recent report has highlighted significant impact of right ventricular (RV) function on mortality and urgent heart transplantation. Taken together, we hypothesized that the assessment of RV function was helpful to predict exercise capacity by using low-load exercise stress echocardiography (low-load ESE) in patients with HF.

Purpose
We evaluated whether RV dysfunction assessed by the low-load ESE determined a low peak VO2 &lt;14 ml/kg/min in patients with HF.

Methods
We studied 67 consecutive hospitalized patients with HF (mean age, 65 years; 75% male; mean LV ejection fraction, 36%) who underwent ESE and CPX after stabilized HF condition, and the time interval of CPX and ESE tests was within 48 hours. CPX was performed using an upright cycle ergometer by a ramp protocol, while ESE was performed using ergometer in semi-supine position and the workload was generally increased by 25 watts every 3 minutes. The low-load ESE was defined as the 25 watts exercise. The increments of RV s' velocity at tricuspid annulus and RV strain in the free wall were considered as a preservation of RV contractile reserve. Among the study population, 26 patients were performed right heart catheterization and RV dP/dt/Pmax was estimated as an invasive marker of RV contractility.

Results
The achieved intensity of exercise was 50.4±21.0 watts, and all patients completed the low-load ESE. The invasive study showed that the change of RV s' velocity during the low-load ESE significantly correlated with RV dP/dt/Pmax (r=0.706, p&lt;0.001). As shown in Figure, the non-invasive parameters of RV contractile reserve during the low-load ESE were significantly correlated with peak VO2 (RV s' velocity: r=0.787, p&lt;0.001; RV strain: r=0.244, p=0.047). ROC analysis showed that the change of RV s' velocity during the low-load ESE correctly identified patients with peak VO2 &lt;14 ml/kg/min (AUC=0.95, sensitivity 92.3%, specificity 85.2%). In terms of inter- and intra-observer variabilities, ICCs of the change of RV s' velocity were 0.86 and 0.96, and ICCs of the changes of RV strain were 0.63 and 0.70, respectively.

Conclusion
The change of RV s' velocity during the low-load ESE could determine exercise tolerance in patients with HF. The assessment of RV contractile reserve might be clinically useful to discriminate high risk HF patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Early detection of skin and cardiac amyloid deposits among asymptomatic carriers of hereditary pathogenic transthyretin mutation with normal electroneuromyography
Authors: Slama M , Eliahou L , Piekarski E , Rouzet F , Beauvais D , Beaudonnet G , Labeyrie C , Cauquil C , Adams D , Algalarrondo V 
Published: November 2020

Abstract

Introduction
During the last decade, disease modifying therapies have been proposed for hereditary amyloidogenic transthyretin (ATTRv) amyloidosis. It is essential to screen for disease onset among asymptomatic mutation carriers in order to trigger effective therapy as early as possible. We describe clinical and paraclinical data from ATTRv asymptomatic carriers, as a baseline assessment to detect disease onset and progression.

Methods
We retrospectively collected data of asymptomatic ATTRv carriers with normal electroneuromyography (ENMG), between March 1st 2015 and January 31st 2019, including: demographics, symptoms, physical exam, ENMG (initial and follow-up obtained in 73 patients, 56.2%), neurovegetative tests, skin biopsy (amyloid deposition, denervation), and cardiac evaluation (multimodal imaging, cardiac denervation and arrhythmias).

Results
We included 130 patients, aged 43.6 years (± 13.5), selected in family of a proband with an age of onset of 52.7 years (±15.7), 40.8% male, carrying 20 different variants of the TTR gene, including 63.8% Val30Met. Amyloid deposits on skin biopsy and/or cardiac fixation on bone scintigraphy, characteristic of amyloid infiltration, were found in 22/130 patients (16%). Skin biopsy was positive in 11 patients, and cardiac fixation on bone scintigraphy was positive in 15 patients. Amyloid infiltration was statistically associated with age (p=0.024), age difference from index case (p&lt;0.001), electrophysiological carpal tunnel syndrome (p=0.022), interventricular septum thickness &gt;12 mm (p&lt;0.001), contrast enhancement in cardiac MRI (p=0.002), cardiac denervation using MIBG scintigraphy C/M ratio &lt;1.85 (p=0.044). Multivariate analysis showed that age difference with index case and interventricular septum thickness were predictors for amyloid infiltration (OR=1.11, IC [1,04–1,19] and OR=1,76, IC [1,19–2,60]). Subgroup analysis showed electroneuromyography alteration during follow up in 11 patients (delay 26.9 months, range 10–49) with statistic association with amyloid deposits (55.6 versus 7.1% when ENMG was unchanged, p&lt;0.001) and interventricular septum thickness (p&lt;0.010).

Conclusion
Clinical and paraclinical assessment of asymptomatic carriers of ATTRv mutations shows that skin or cardiac amyloid infiltration may precede ENMG abnormalities in 16% of patients. This may trigger specific therapies in borderline cases. Age close to age of onset among index case and septum interventricular thickness appear as risk factors for developing electroneuromyogram alteration.

Funding Acknowledgement
Type of funding source: None
Shear wave elastography: can we estimate filing pressures?
Authors: Werner A.E , Bezy S , Orlowska M , Kubiak G , Desmet W , Delcroix M , Van Cleemput J , Ince H , D'hooge J , Voigt J.U 
Published: November 2020

Abstract

Background
The assessment of the left ventricular diastolic function is complex, as there is no single non-invasive parameter that provides a direct measurement of myocardial relaxation, myocardial compliance, or – as a surrogate - LV filling pressure. Estimation of diastolic function is therefore based on the combination of many parameters.
Shear wave (SW) elastography (SWE) is a novel method based on high frame rate echocardiography. SWs occur after mechanical excitation of the myocardium, e.g. after mitral valve closure (MVC), and their propagation velocity is directly related to myocardial stiffness (MS).

Purpose
The aim of this study was to investigate if velocities of natural shear waves are related to MS at end diastole (ED) and, thus, could be used to estimate left ventricular end-diastolic pressures (LVEDP) as marker of diastolic function.

Methods
So far, we have prospectively enrolled 30 patients with a wide range of diastolic function, scheduled for heart catheterization so that LV filling pressures could be invasively measured. Patients with severe aortic stenosis, mitral stenosis of any degree and a more than moderate mitral regurgitation, as well as regional myocardial abnormalities or dysfunction in the anteroseptal wall were excluded.
Echocardiography was performed immediately after catheterization. SW elastography in parasternal long axis views of the left ventricle (LV) was performed using an experimental scanner (HD-PULSE) at 1100±250 frames per second. Tissue acceleration maps were extracted from an anatomical M-mode line along the midline of the LV septum. The SW propagation velocity at MVC was measured as the slope on the M-mode acceleration map (Figure A).

Results
SW velocities at ED correlated very well with the invasively measured LVEDP (r=0.815, p&lt;0.001, Figure B). In comparison, classical echocardiographic parameters correlated only weakly or not with LVEDP (E/A: r=0.528, p=0.036, Figure C; E/e': r=−0.169, p=0,531, Figure D) with LVEDP.
For the detection of an elevated LVEDP above 15 mmHg, a cut off value for the SW velocity at MVC of 3.75 m/s was associated with a Sensitivity of 92.9% and a Specificity of 83.3%.

Conclusions
End-diastolic shear wave velocities, measured by high frame rate shear wave elastography, showed a significant correlation with the end-diastolic filling pressure of the LV indicating a potential clinical value of the new method for a non-invasive and direct assessment of LV diastolic function. More patients will be included to confirm these findings.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Fonds Wetenschappelijk Onderzoek Flanderen (Research Foundation Flanders)
Hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy: mid-term results
Authors: Klein P , Van Kuijk J.P , Swaans M.J 
Published: November 2020

Abstract

Background
Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF).

Purpose
We describe the mid-term results of a novel hybrid transcatheter and minimally invasive surgical technique to reconstruct the remodelled LV by plication and exclusion of the scar and reduction of the excess volume, resulting in decreased wall stress and increased EF.

Methods
Patients were considered eligible for the procedure when the presented with symptomatic heart failure (NYHA-class II or more) and ischemic cardiomyopathy (EF&lt;40%) after anterior myocardial infarction. All patients had a dilated LV with either an a- or dyskinetic scar in the anteroseptal wall and/or apex of &gt;50% transmurality. An hybrid transcatheter and minimally technique was used that relies on deploying a series of paired internal and external micro-anchors to plicate fibrous scar of infarcted anterior wall myocardial tissue to reconstruct the LV.

Results
Between October 2016 and January 2020 24 patients (21 males, 3 females; mean age 61±13 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.9 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 34±9% to 44±11% (change +34%, P&lt;0.0001) and LV-volumes decreased: LVESV 113 ml ± 54 ml to 68±41 ml (change −39%, P&lt;0.0001) and LVEDV 166 ml ± 75 ml to 116±57 ml (change −30%, P&lt;0.0001). One patient was converted peroperatively to full sternotomy, ECC and cardioplegic arrest because of partial dislodgement of an apical mural thrombus. After removal of the thrombus, the LV was reconstructed with 2 anchor-pairs. One patient underwent a postoperative revision because of RV restriction. After removal of 1 “RV-LV” anchor-pair, the patient made a full recovery. One patient underwent an uncomplicated minimally invasive tricuspid valve replacement because of a lesion to the tricuspid valve during the procedure. Hospital mortality was 0%. Median duration of ICU–stay was 2 days (IQR 1–46 days) and median length of hospital stay was 7 days (IQR 5–57 days). Survival at 36 months was 88%. At latest follow-up, 86% of surviving patients were in NYHA-class I-II compared to 21% preoperatively.

Conclusions
Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Mid-term results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and improvement in heart failure symptoms.
Revivent TC technique

Funding Acknowledgement
Type of funding source: None
Restricted mean survival time analysis in heart failure clinical trials
Authors: Perego C , Sbolli M , Specchia C , Oriecuia C , Peveri G , Fiuzat M , O'Connor C.M , Metra M , Wei L.J , Psotka M.A 
Published: November 2020

Abstract

Background
The hazard ratio (HR) is the most common measure used to quantify treatment effects in heart failure (HF) clinical trials. However, the HR is only valid when the proportional hazards assumption is plausible, and the HR may be difficult to interpret for clinicians and laypeople. Restricted mean survival time (RMST), defined as the average time-to-event before a specific timepoint, is an intuitive summary of group-wise survival. The difference between two RMSTs measures treatment effects without model assumptions and may communicate more clinically interpretable results.

Purpose
To evaluate statistical and clinical properties of RMST-based statistics applied to clinical trial data for treatments of HF with reduced ejection fraction.

Methods
Patient time-to-event data was reconstructed from the published primary and secondary outcome Kaplan-Meier curves from landmark HF clinical trials. We estimated the RMST-differences between treatment groups as a measure of treatment effect with published data, and compared statistical testing results and effect size values to HR analysis results.

Results
We analyzed 7 HF clinical trials, including data from a total of 27,845 patients (Table 1). RMST should be interpreted as the average number of months that the outcome is avoided over the study period. As examples: On average, treatment with enalapril for 12 months extended each patient's life by 2.2 months compared to placebo, and treatment with spironolactone for 34 months extended each patient's life by 2.2 months compared to placebo.

Conclusions
RMST-difference test statistic has identical statistical conclusions as HRs but provided an intuitive estimate of each treatment effect. RMST-based data can potentially be used to better communicate treatment effects to patients, to assist in patient-preference discussions and shared decision-making

Funding Acknowledgement
Type of funding source: None
Impacts of beta-blockers on lone term clinical outcomes in the treatment of hospitalized heart failure patients with an ejection fraction greater than 40%
Authors: Xing F , Li J.I.N.G 
Published: November 2020

Abstract

Background
Heart failure (HF) is a leading cause of mortality and morbidity. Beta-blocker is recommended in HF with reduced ejection fraction (EF) in order to improve clinical outcomes. While the effects of beta-blockers in HF who have an EF greater than 40% are uncertain and controversial yet.

Purpose
To Investigate the associations between beta-blockers and clinical outcomes, overall and in strata of patients with an EF of between 40% and 49% or greater than 50%.

Methods
The study cohort included 2642 HF patients hospitalized primarily for HF who had an EF greater than 40%, which was from the China PEACE Prospective Heart Failure Study. We had two Clinical outcomes: 1-year all-cause mortality and 1-year hospitalization for HF after discharge. The associations between beta-blockers and clinical outcomes were assessed using Cox proportional hazard regression models, while stratified according to EF.

Results
The median age was 70 (IQR: 61, 77) years, 44.8% were women, EF was (median (IQR)) 54% (46%, 62%), and 55.5% received beta-blockers at discharge. All-cause mortality and hospitalizations for HF occurred in 341 (12.91%) and 636 (24.07%) patients respectively. In the Cox proportional hazard analysis, a significant interaction between EF and beta-blocker use for mortality was observed (P=0.01 for interaction). Stratified analysis showed beta-blockers reduced risks of mortality in patients who had an EF between 40% and 49% ((hazard ratios (HR): 0.501, 95% confidence interval (CI): 0.340- 0.738, p&lt;0.001), but not among patients with an EF of 50% or greater (HR: 0.824, 95% CI: 0.600- 1.133, p=0.233). Use of β-blockers was not associated with reduced hospitalizations in patients with EF of between 40% and 49% and greater than 50% (HR: 1.016, 95% CI: 0.712- 1.450, p=0.931; HR: 0.905, 95% CI: 0.703- 1.166, p=0.439, respectively).

Conclusion
For patients with an EF between 40% and 49%, β-blocker use was associated with a reduced risk of all-cause mortality but not HF hospitalizations. For patients with an EF of 50% or greater, there was no such association.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): This work was supported by the National Key Research and Development Program (2017YFC1310803) from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science (2017-I2M-B&R-02); the 111 Project from the Ministry of Education of China (B16005).
Aerobic physical training improves skeletal muscle metabolism in heart failure patients
Authors: Galenko V , Lelyavina T.A , Bortsova M.A , Sitnikova M.Y 
Published: November 2020

Abstract

Purpose
To evaluate the efficiency of aerobic physical rehabilitation (PR), selected on the basis of lactate threshold achievement during cardiopulmonary exercising test (CPET), in heart failure patients with normal body mass index (BMI); to study metabolism changes in skeletal muscle fibers (MF) after PR.

Methods
100 patients; heart failure with reduced ejection fraction (HFrEF), NYHA III, mean age 52±5.2 years, ejection fraction (EF) 27.3±4.2%, BMI 23.5±2.8 kg/m2. The original estimated CPET, exercise tolerance (ET), quality of life (QOL) and echocardiography (EchoCG). Effects of physical rehabilitation were estimated on the basis of peak oxygen uptake (VO2peak), EF, QOL and ET dynamics after 6 months of training. Shin muscle biopsy was performed at baseline and after 3–6 months of training programm. In muscle samples activity of lactate dehydrogenase (LDH), succinate dehydrogenase (SDG) and alkaline phosphatase (AP) was evaluated with plag-method. Data were statistically processed using software package Statistika, 9.0.

Results
After 6 months of physical training ET increased by 9.7±0.5 points and QOL improved by 24.8±3.5 points (p1,2 &lt;0.05), EF increased by 10.5±2.3% and VO2 peak increased by 5.2±0.5 ml/min/kg (p3,4 &lt;0.05). After 3–6 months of training AP activity increased by 24.2% (p&lt;0.05). LDH activity in glycolytic MF decreased by 24.4%, in oxidative MF it decreased by only 6.0% (p1 &lt;0.05, p2&gt;0.05). SDG activity in glycolytic MF increased by 30% and in oxidative – by 20% (p1,2 &lt;0.05). There was a positive relation between SDG activity and VO2 peak dynamics (r=0.6, p=0.04), increase in CPET parameters was associated with AP activity (r=0.5, p=0.05).

Conclusion
Aerobic physical training in stable HFrEF patients with normal BMI was effective in improving values of EF, VO2 peak, QOL and ET;
Participating in the rehabilitation program decreased LDH activity in both oxidative and glycolytic muscle fibers; it also significantly increased AP activity and SDG activity in both oxidative and glycolytic MF. This may indicate a decrease in glycolytic metabolism activity and aerobic metabolism activation;
The relation between the increase in exercise tolerance and endothelium condition marker (AP activity in muscle tissue), SDG activity and VO2 peak dynamics has been revealed.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Project was partially funded by the Russian Science Foundation grant 16-15-1017