bluuebunny/crossref_metadata_2025_split huggingface dataset:
The comparison between two different exercise training programs on the mobilization of endothelial progenitor cells in patients with chronic heart failure
Authors: Kourek C , Psarra K , Alshamari M , Delis D , Mitsiou G , Ntalianis A , Panagopoulou N , Papadopoulos C , Nanas S , Karatzanos E 
Published: November 2020

Abstract

Background
Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are being used as an index of vascular endothelial function. Cardiac rehabilitation (CR) programs have been shown to stimulate the mobilization of EPCs in CHF patients. However, the effect of different exercise training programs on the EPCs in CHF patients has not been investigated.

Purpose
The purpose of the study was to assess the effect of 2 different exercise training programs on the mobilization of EPCs in patients with CHF and investigate if there were differences between them.

Methods
Forty-four consecutive patients (35 males) with stable CHF [mean±SD, Age (years): 56±10, EF (%): 33±8, Peak VO2 (ml/kg/min): 18.4±4.4] enrolled a 36-session CR program and they were randomized in one exercise training protocol; either high-intensity interval training (HIIT) or HIIT combined with muscle strength (COM). Venous blood was drawn at rest before and after the CR program. Five circulating endothelial populations were identified and quantified by flow cytometry (Table 1). EPCs values are expressed as cells/million enucleated cells in medians (25th-75th percentiles).

Results
In both HIIT and COM groups, the mobilization of all circulating endothelial populations increased after the CR program (p&lt;0.05, Table 1). However, there was no difference in the mobilization of EPCs between HIIT and COM groups (p&gt;0.05, Table 1).

Conclusion
A 36-session cardiac rehabilitation program increases the mobilization of endothelial progenitor cells in patients with chronic heart failure. High-intensity interval exercise training and HIIT combined with muscle strength have similar beneficial effect on endothelial progenitor cells, and therefore on vascular endothelial function.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): Co-financed by Greece and the European Union (European Social Fund- ESF) through the Operational Programme “Human Resources Development, Education and Lifelong Learning” in the context of the project
Regional muscle-adipose distribution is different in patients with heart failure with preserved or reduced ejection fraction
Authors: Ishikawa H , Izumiya Y , Shibata A , Yoshida T , Hayashi H , Ichikawa Y , Yamaguchi Y , Kitada R , Ehara S , Yoshiyama M 
Published: November 2020

Abstract

Background
Epicardial adipose tissue (EAT) has been recognized to contribute inflammatory activity and atherosclerosis. On the other hand, it has been reported that the volume of EAT is lower in non-ischemic heart failure (HF) patients than healthy individuals. However, the difference in regional muscle-adipose distribution including EAT between HF with preserved ejection fraction (HFpEF) and HF reduced ejection fraction (HFrEF) has not been investigated. In addition, we investigated whether distribution of body composition contributed to exercise capacity.

Methods
The study included 105 non-ischemic HF patients diagnosed by cardiac catheterization between September 2017 and November 2019. Epicardial, abdominal and thigh muscle and adipose tissue volume were measured by computed tomography (CT), and exercise tolerance was evaluated by symptom-limited cardiopulmonary exercise test.

Results
Patients were divided into 2 groups according to the left ventricular ejection fraction, ≥40% as HFpEF (n=28) or &lt;40% as HFrEF (n=77). There was no significant difference comorbidity, including hypertension, dyslipidemia, chronic kidney disease, and body mass index. Plasma B-type natriuretic peptide level was significantly higher in HFrEF than HFpEF group (146.2 vs 393.2 pg/ml, p&lt;0.01), whereas, high-sensitive troponin T level was not different between two groups. Although there was no significant difference in BMI between two groups, the volume of EAT was significantly higher in HFpEF than HFrEF group (81.8 vs 136.4 ml, p=0.01). On the other hand, HFpEF had more thigh adipose tissue compared with HFrEF group (54.6 vs 42.1 ml, p=0.03). There were negative correlations between EAT volume and parameters of exercise capacity such as anaerobic threshold (r=−0.42, p&lt;0.01) and peak VO2 (r=−0.32, p&lt;0.01). Muscle volume itself does not corelate with these parameters.

Conclusion
In patient with nonischemic HF, the pattern of regional adipose distribution may have important role in pathologically. HFpEF and HFrEF has different pattern despite similar body mass index. These differences may be related to impaired exercise tolerance in these 2 different types of HF.
Correlation between EAT and AT, peak VO2

Funding Acknowledgement
Type of funding source: None
Prognostic significance of 2019 Asian Working Group for Sarcopenia update on definition of sarcopenia
Authors: Saito K , Matsue Y , Kamiya K , Saito H , Ogasahara Y , Kitai T , Konishi M , Maekawa E , Iwata K , Jujo K , Wada H , Kasai T , Nagamatsu H , Momomura S , Kagiyama N 
Published: November 2020

Abstract

Background/Introduction
Sarcopenia plays a major role in the pathophysiology of frailty and is associated with worse outcome in the elderly population including patients with heart failure. A recent update of the most common definition of sarcopenia in Asia, Asian Working Group for Sarcopenia (AWGS2019), included significant changes in the diagnostic algorithm with newly dividing sarcopenia into severe and “non-severe” sarcopenia.

Purpose
The objective of this study was to evaluate the differences between AWGS2014 and AWGS2019 in patients with heart failure.

Methods
In the multicenter prospective FRAGILE-HF registry, which included elderly (≥65 years old) patients who were hospitalized with heart failure, we studied 865 patients (80±8 years old, 42% female). All-cause death in 1-year follow-up was tracked.

Results
Based on the original version of AWGS (AWGS2014), 183 patients (21%) were diagnosed with sarcopenia, which was associated with higher age, lower physical performance, less muscle mass, and greater heart failure risk (all p&lt;0.001) as well as higher rate of all-cause death (HR 1.90, p=0.004 after adjustment by multivariable regression). Those patients with sarcopenia by AWGS2014 were reclassified mainly to severe sarcopenia (155, 84.7%) by AWGS2019, and 25 (13.7%) and 2 (1.1%) were classified into sarcopenia and non-sarcopenia. Meanwhile, 24 (3.5%) and 4 (0.6%) of patients without sarcopenia by AWGS2014 were reclassified into sarcopenia and severe sarcopenia, respectively. Although severe sarcopenia by AWGS2019 was associated with higher age, lower physical performance, less muscle mass, and greater heart failure risk (all p&lt;0.001), patients with “non-severe” sarcopenia was rather younger (p&lt;0.001) and had better physical performance (p=0.021) despite less muscle mass (p&lt;0.001) than those without sarcopenia. Multivariate Cox analysis demonstrated severe sarcopenia by AWGS2019 was an independent prognostic factor (HR 1.77, p=0.014), but “non-severe” sarcopenia was not (HR 1.52, p=0.37). The prognosis of patients who were reclassified from non-sarcopenia to sarcopenia or severe sarcopenia were comparable to those remained non-sarcopenia. When added to other risk factors, the prognostic predictability of AWGS2019 was significantly lower than AWGS2014 (net reclassification improvement −0.26, p=0.025).

Conclusions
About a half of “non-severe” sarcopenia in AWGS2019 were patients without sarcopenia in AWGS2014. The prognosis of such patients who were newly diagnosed as sarcopenia was good, resulting in low overall prognostic predictability of AWGS2019. A further consideration for diagnostic algorithms of sarcopenia may be warranted in patients with heart failure.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Japan Heart Foundation
Predictors of 5-year mortality in patients with congestive heart failure and implanted devices for cardiac resynchronization therapy
Authors: Soldatova A , Kuznetsov V.A , Dyachkov S.M 
Published: November 2020

Abstract

Cardiac resynchronization therapy (CRT) has a wide range of therapeutic benefits including reduction in hospitalizations and death in appropriately selected patients, while the appropriate selection remains the cornerstone of CRT. Apart from the current selection criteria, many additional factors may play an incremental role affecting cardiac prognosis and CRT efficacy.

Aim
To examine the ability of a multiparametric score to predict 5-year mortality in patients with congestive heart failure (HF) treated with CRT.

Methods
The study enrolled 218 HF patients (83% men, 17% women; mean age of 58.7±10.7 years) with left ventricular ejection fraction (LVEF) ≤35%, NYHA class II-IV. 130 patients (59.6%) had ischemic etiology of HF (84 with prior myocardial infarction), 88 patients (31.4%) – non-ischemic cardiomyopathy. 57.3% of patients had left bundle branch block (LBBB), mean QRS width was 150.5±38.4 ms.

Results
The mean follow-up period was 38.8±20.9 months. The 5-year survival was 69.3%. Points were calculated from 11 parameters identified as factors associated with all-cause mortality in multivariate analysis: gender (female – 0, male – 1); etiology of HF (non-ischemic – 0, ischemic – 1); history of myocardial infarction (no – 0, yes – 1); NYHA (II or III – 0, IV – 1); QRS (≥150 ms or ≤120 ms + 3 parameters of mechanical dyssynchrony – 0, 120–149 ms – 1); rhythm (sinus or radiofrequency ablation of atrial fibrillation (AF) – 0, AF – 1); LBBB (LBBB – 0, non-LBBB – 1); LVEF (&gt;30% – 0, ≤30% – 1); frailty (not frail – 0, frail – 1); PR interval (&lt;200 ms – 0; ≥200 ms – 1); NT-proBNP (median value) (&lt;1788 pg/ml – 0, ≥1788 pg/ml – 1). To calculate the score, the sum of points was divided by the number of parameters. If less than 3 items were missing the denominator adjusted accordingly. The 5-year survival rate for patients with highest tertile score (&gt;0.44; n=43) was 43.1%, for middle tertile (0.44≤ score ≥0.22; n=124) – 73.4% and 88.4% for lowest tertile (&lt;0.22; n=51) (Log rank p&lt;0.001).

Conclusions
Multiparametric score can be used to predict 5-year mortality in patients with CRT.
Survival curves in groups by tertiles

Funding Acknowledgement
Type of funding source: None
Improving quality of life post left ventricular assist device surgery with CardioMEMS hemodynamic guided management
Authors: Veenis J.F , Radhoe S.P , Brugts J.J 
Published: November 2020

Abstract

Background/Introduction
Left ventricular assist device (LVAD) surgery improves quality of life (QoL) in chronic heart failure patients. Hemodynamic optimization of the LVAD therapy can improve patient outcomes, and potentially further improve QoL in these patients.

Purpose
In this analysis, we assessed the improvement of the QoL post-LVAD surgery in patients with hemodynamic guided management by the CardioMEMS.

Methods
Ten patients suffering from chronic heart failure, who underwent (semi-)elective LVAD surgery and participated in the HEMO-VAD pilot study, were included in this analysis. All patients received a CardioMEMS sensor pre-LVAD surgery. The daily hemodynamic readings were used to guide patient management, pre- and post LVAD surgery. The aim was to normalize and keep the mean pulmonary artery pressure (mPAP) normalized (≤25 mmHg). For this analysis, patients were divided into those with a normal mPAP at all the scheduled follow-up moments at 3, 6, and 9 months post-LVAD surgery and those with an elevated mPAP during at least one of the follow-up moments. QoL was assessed by the EQ-5D-5L, KCCQ and PHQ-9 questionnaires at baseline (pre-LVAD surgery) and 3, 6 and 9 months post-LVAD surgery.

Results
The median age was 60 [52–63] years, and 70% of patients were men. In the hemodynamic normalized patients, QoL improved significantly between pre-LVAD surgery and the post-LVAD surgery follow-up moments, while no significant improvement was observed in the non-hemodynamic normalized patients. An increase of 37 points on the overall summary score of the KCCQ (p=0.046) was observed in the hemodynamic normalized patients, compared to a 22 points increase in the non-hemodynamic normalized patients (p=0.655), similar improvements were observed for the clinical summary score of the KCCQ, the visual analog scale of the EQ-5D and in the PHQ-9. Additionally, a trend towards a bigger improvement in the QoL was observed in the hemodynamic normalized patients, compared to the non-hemodynamic optimized patients (Figure).

Conclusion(s)
Successful hemodynamic management of LVAD patients, guided by CardioMEMS improves the QoL during the first year post-LVAD surgery. Patients who were hemodynamically normalized had a better QoL, and a bigger improvement in QoL from baseline, compared with non-hemodynamically optimized LVAD patients.
Figure 1. Absolute and paired change in A EQ-5D-5L index value; B EQ-5D-5L visual analog scale, C KCCQ clinical summary score, D KCCQ overall summary score, E PHQ-9 score from baseline to 9 months of follow-up according to hemodynamically optimized status

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): This work was supported by Abbott with an independent research grant, partially covering personnel costs. This study was investigator-initiated and was designed, conducted, interpreted and reported independently of the funder.
Multi-year improvement in autonomic tone, baroreceptor sensitivity, and cardiac electrical stability using vagus nerve stimulation in patients with HFrEF in the ANTHEM-HF study
Authors: Nearing B.D , Libbus I , Anand I.S , Dicarlo L.A , Kenknight B.H , Verrier R.L 
Published: November 2020

Abstract

Background
HFrEF patients experience long-term deterioration of autonomic function and cardiac electrical stability linked to increased sudden cardiac death risk. ANTHEM-HF (NCT01823887) reported improved baroreceptor sensitivity (heart rate turbulence, HRT), heart rate variability (rMSSD), and reduced cardiac electrical instability (T-wave alternans, TWA) after 12 months of chronic vagus nerve stimulation (VNS). It is unknown whether these benefits persist long-term.

Methods
HRT, rMSSD, TWA, and VT occurrence were evaluated during chronic VNS in all patients with symptomatic HFrEF with available 36-month follow-up data (n=25). ECGs were analyzed before Autonomic Regulation Therapy system implantation (LivaNova USA) and after chronic cervical VNS.

Results
Improvement in HRT slope persisted at 24 months (8.1±1.2 ms/RR interval, p=0.02) and 36 months (7.9±0.9 ms/RR interval, p=0.03) of VNS compared to baseline. RMSSD increase continued at 24 months (34.6±2.7 ms2, p&lt;0.02) and 36 months (36.4±2.0 ms2, p=0.002). Peak TWA levels remained reduced at 24 months (47.8±1.3 μV, p&lt;0.0001) and 36 months (46.1±1.6 μV, p&lt;0.0001). No sudden death, VF, or sustained VT occurred, and patients with nonsustained VT decreased from 11 (44%) at baseline to 1 (5%) at 24 months (p&lt;0.003) and 2 (11%) at 36 months (p&lt;0.02).

Conclusion
In patients with HFrEF, chronic VNS appears to confer persistent 3-year improvements in autonomic tone, baroreceptor sensitivity, and cardiac electrical stability.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): LivaNova PLC
Symptomatic endpoint responder rates to BAROSTIM Therapy
Authors: Abraham W.T , Lindenfeld J , Weaver F , Zannad F , Zile M , Galle E , Schafer J , Bahu M 
Published: November 2020

Abstract

Background
Patients with heart failure with reduced ejection fraction (HFrEF) have varying responses to symptomatic endpoints with device-based HF therapies.

Purpose
Evaluate the symptomatic response to baroreflex activation therapy (BAT) at six months.

Methods
In a trial of subjects with NYHA Class II (recently III) or III HFrEF, left ventricular EF≤35%, guideline directed medical HF therapy (GDMT), no indication for cardiac resynchronization therapy, and NT-proBNP&lt;1600 pg/ml, 264 subjects were randomized to BAROSTIM therapy plus GDMT (BAT group) or GDMT alone (Control group). Six-minute hall walk (6MHW), Minnesota Living with HF (QOL) and NYHA Class were analyzed. Clinically relevant responders were defined by 6-month improvement in 6MHW&gt;10%, QOL&gt;5 points or improvement in at least one NYHA class; super responders were defined by 6-month improvement in 6MHW&gt;20%, QOL&gt;10 points or improvement to NYHA class I.

Results
Both clinically relevant and super responders were significantly higher in BAT versus Control subjects for all symptomatic endpoints. In BAT subjects, 72% had clinically relevant improvements in ≥2 endpoints compared to 29% of Control subjects (p&lt;0.001), and 28% of BAT subjects had super responder improvements in ≥2 endpoints versus 10% of Control subjects (p&lt;0.001).

Conclusion
Among subjects with symptomatic HFrEF, treatment with BAT resulted in clinically relevant and super responder rates. The BAT clinically relevant and super responder rates are similar to those seen with CRT, in CRT-indicated patients.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): CVRx, Inc.
Selfcare management intervention in heart failure (SMART-HF) -a multicentre randomized controlled trial
Authors: Sahlin D.S , Melander O , Gerward S 
Published: November 2020

Abstract

Background
Clinical studies evaluating home-based interventions for heart failure (HF) patients are performed on patients that are too young, too often male and predominately have reduced ejection-fraction (EF). The Selfcare Management Intervention in Heart Failure (SMART-HF) study was designed to evaluate a digital intervention enhancing self-care behaviour in a more generalizable population. The aim was to see if the intervention could reduce in-hospital care due to HF.

Methods
SMART-HF was a randomized controlled trial, recruiting patients from seven centres in Region Skåne. Patients were randomized 1:1 to a control group (CG) receiving standard care or an intervention group (IG) who were equipped with the digital intervention. The intervention educates the patient about HF and supports the patient with medication and symptom monitoring, also notifying the patient in case of deterioration. The primary outcome was number of in-hospital days due to HF after 240 days follow-up.

Results
A total of 124 patients were randomized and 118 (CG: 60, IG: 58) were included in the analysis. The mean age was 79 years, 39% were women and 45% had EF &lt;40%. The groups were well balanced at randomization. A total of 367 HF in-hospital days were registered among 33 patients, and patients in the IG lost on average 2.2 days fewer to HF-hospitalizations than patients in the CG, a reduction by 52%, p&lt;0.001. An unadjusted Cox-regression to analyse the event-free survival yielded a hazard ratio = 0.50 (CI:0,24–0,96), p=0.046. The self-care behaviour was 21% better in the IG, p=0.014. The median system adherence was 85% after 240 days.

Conclusions
The intervention significantly reduced HF-related in-hospital days and improved event-free survival in a representative HF-population. The findings match previous published data from studies evaluating the same intervention.

Funding Acknowledgement
Type of funding source: None
Association between clinical risk factors and left ventricular function in patients with breast cancer following chemotherapy
Authors: Yamashita K , Tanaka H , Hatazawa K , Tanaka Y , Sumimoto K , Shono A , Suzuki M , Yokota S , Suto M , Mukai J , Takada H , Matsumoto K , Minami H , Hirata K 
Published: November 2020

Abstract

Background
The sequential or concurrent use of two different types of agents such as anthracyclines and trastuzumab may increase myocardial injury and cancer therapeutics-related cardiac dysfunction (CTRCD), which is often the result of the combined detrimental effect of the two therapies for breast cancer patients. For risk stratification to detect the development of CTRCD, the current position paper from the European Society of Cardiology (ESC) lists several factors associated with risk of cardiotoxicity following treatment with chemotherapy. However, the association between clinical risk factors and left ventricular (LV) function in breast cancer patients is currently unclear.

Purpose
Our purpose was to investigate the impact of baseline risk factors on LV function in patients with preserved LV ejection fraction (LVEF) who have undergone anthracycline or trastuzumab chemotherapy for breast cancer.

Methods
We studied 86 breast cancer patients treated with anthracyclines, trastuzumab, or both. Mean age was 59±13 years and LVEF was 67±5%. In accordance with the current definition, CTRCD was defined as a decline in LVEF of &gt;10% to an absolute value of &lt;53% after chemotherapy. Based on the 2016 ESC position paper, clinical risk factors for CTRCD were defined as: (1) a cumulative total doxorubicin dose of ≥240 mg/m2, (2) age ≥65-year-old, (3) body mass index ≥30 kg/m2, (4) a previous history of radiation therapy to chest or mediastinum, (5) B-type natriuretic peptide ≥100pg/mL, (6) a previous history of cardiovascular disease, (7) atrial fibrillation, (8) hypertension, (9) diabetes mellitus, (10) current or ex-smoker.

Results
The relative decrease in LVEF after chemotherapy for patients with more than four risk factors was significantly greater than that for patients without (−9.3±10.8% vs. −2.2±10.2%; p=0.02). However, this finding did not apply to patients with more than one, two or three risk factors. Patients with more than four risk factors also tended to show a higher prevalence of CTRCD than those without (14.3% vs. 2.8%, p=0.12). Moreover, patients with more than four risk factors were more likely to have higher LV mass index (109.3±29.0 g/m2 vs. 83.2±21.0g /m2, p&lt;0.001), lower global longitudinal strain (18.4±2.8% vs. 20.0±2.6%, p=0.06) and higher E/e' (10.4 (8.9–13.0) vs. 9.0 (7.4–10.9), p=0.06) compared to those without.

Conclusions
Association between clinical risk factors and LV dysfunction following chemotherapy became stronger with an increase in the number of risk factors in breast cancer patients, and was especially strong for patients treated with chemotherapy who had more than four risk factors. Our findings can thus be expected to have clinical implications for better management of patients with breast cancer referred for chemotherapy.

Funding Acknowledgement
Type of funding source: None