bluuebunny/crossref_metadata_2025_split huggingface dataset:
Three-year outcomes of selective incomplete versus complete revascularization in heart failure patients receiving multivessel percutaneous coronary intervention
Authors: Chang C , Hsieh M , Chen D , Chen C , Hsieh I 
Published: November 2020

Abstract

Background
Heart failure (HF) patients with multi-vessel disease (MVD) are often associated with comorbidities to limit the possibility to achieve complete revascularization (CR) in percutaneous coronary intervention (PCI). The planned selective incomplete revascularization (SIR) may be an alternative opinion for these patients.

Purpose
To investigate 3-year clinical outcomes of SIR versus CR in HF patients with MVD in a real-word registry.

Methods
A total of 566 HF patients with MVD receiving either SIR or CR were enrolled. SIR was planned pre-PCI based on clinical exams to avoid non-viable tissue revascularization. Major adverse cardiac events (MACEs) was a composite of in-hospital death, recurrent myocardial infarction, any revascularization, and all-cause death at 3-year follow-up.

Results
There was no significant differences between SIR and CR groups in in-hospital death, any revascularization, all-cause death and MACEs (24.3% vs. 24.9%, p=0.922). However, SIR had a significant lower incidence of recurrent myocardial infarction than CR (3.2% vs. 7.2%, p=0.032).

Conclusion
The 3-year outcomes of PCI with planned SIR were completely comparable to with CR in HF patients with MVD. Planned SIR can be an opinion for HF patients with MVD who are not suitable to achieve CR.
Kaplan-Meier curve of 3-year MACEs

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Chang Gung Medical Research Program
Social frailty provides additive prognostic impact on one-year outcome in aged patients with congestive heart failure
Authors: Jujo K , Kagiyama N , Kamiya K , Saito H , Saito K , Ogasahara Y , Maekawa E , Konishi M , Kitai T , Iwata K , Wada H , Kasai T , Nagamatsu H , Ozawa T , Matsue Y 
Published: November 2020

Abstract

Background
Frailty is associated with multisystem declines in physiologic reserve and increased vulnerability to stressors, resulting in increased risks of adverse clinical outcomes in patients with heart failure (HF). Although frailty is conceptualized as an accumulation of deficits in multiple areas, most of the studies have focused mainly on physical frailty, and the social domains is one of the least investigated area.

Objectives
We prospectively evaluated the incidence and prognostic implication of social frailty (SF) in older patients with HF.

Methods
The FRAGILE-HF is a multicenter, prospective cohort study including patients hospitalized for HF and aged ≥65 years old. We defined SF by Makizako's 5 items, which are 5 questions proposed and validated to be associated with future disability. The primary endpoint of this study was a composite of death from any cause and rehospitalization due to HF. The impact of SF on all-cause mortality alone was also evaluated.

Results
Among 1,240 hospitalized HF patients, 5 simple questions revealed that 825 (66.5%) were in SF. During 1-year observation period after the discharge, the combined endpoint was observed in 399 (32.2%) patients, and 145 (11.7%) patients died. Kaplan-Meier analysis showed that SF patients had significantly higher rates of both the combined endpoint and all-cause mortality than those without SF (Log-rank test: p&lt;0.05 for both, Figures). Moreover, SF remained independently associated with higher event rate of the combined endpoint (hazard ratio: 1.30; 95% confidence interval: 1.02 to 1.66; p=0.038) and all-cause mortality (hazard ratio: 1.53; 95% confidence interval: 1.01 to 2.30; p=0.044), even after adjusting for other covariates. Significant incremental prognostic value was shown when information on social frailty was added to known risk factors for combined endpoint (NRI: 0.189, 95% confidence interval: 0.063–0.316, p=0.003) and all-cause mortality (NRI: 0.234, 95% confidence interval: 0.073–0.395, p=0.004).

Conclusions
Among older hospitalized patients with heart failure, two-thirds of the population was with SF. Evaluating SF provides additive prognostic information in elderly patients with heart failure.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Novartis Pharma Research Grants, Japan Heart Foundation Research Grant
The integrated role of NT-pro BNP and STE-GLS for the early detection of chemotherapy-induced cardiotoxicity
Authors: Youssef G , Sulaiman L , Hisham D , Abdel Hamid M 
Published: November 2020

Abstract

Background
Chemotherapeutic agents, used for the treatment of breast cancer, have many side effects, among them is cardiomyopathy. Ejection fraction (EF) is fails to detect the subtle alterations of left ventricular (LV) function. There comes the need for a more sensitive tool for the detection of preclinical chemotherapy-induced cardiomyopathy.

Aim
Detection of subclinical LV systolic dysfunction in breast cancer patients after 6 weeks of the initiation of their chemotherapeutic treatment, using N-terminal pro brain natriuretic peptide (NT-proBNP) plasma level as well as Speckle tracking echo-global longitudinal strain (STE-GLS).

Methods
Seventy-four asymptomatic, non-metastasizing breast cancer female patients were included. They were assessed before taking their first chemotherapeutic session and 6 weeks thereafter. Assessment included baseline clinical characteristics, conventional two-dimensional (2D) as well as three-dimensional (3D) echocardiography. Loops of different apical views were recorded for later offline STE-GLS analysis. Blood samples for NT-BNP plasma level were collected before and 6 weeks after the initiation of chemotherapy. Samples were later analyzed using a Sandwich ELISA technique.

Results
The median NT-proBNP almost doubled after 6 weeks of chemotherapy (73.50 vs 34.4 pg/L, p value &lt;0.001). One patient died before her scheduled follow up visit, and the cause of death is unknown. Fifty patients showed NT-proBNP elevation at their follow up, compared to the baseline visit, 22 (44%) of them had worse (less negative) LV-GLS in their follow up visit. Five patients had an abnormally elevated NT-proBNP plasma level, all of them had a worse follow up LV-GLS. Only two patients showed significant reduction of LVEF &gt;10% to less &lt;53% (chemotherapy-induced cardiotoxicity) but their NT-proBNP did not exceed the cutoff limit.

Conclusion
The integration of LV-GLS and NT-proBNP is useful in the diagnosis of subclinical, subtle chemotherapy-induced cardiotoxicity. Early detection will prompt early cardioprotective measures and thus helps improving the clinical outcomes.

Funding Acknowledgement
Type of funding source: None
Natural history and prognostic significance of anaemia and iron deficiency in ambulatory patients with heart failure
Authors: Graham F.J , Masini G , Pellicori P , Cleland J.G.F , Kazmi S , Clark A.L 
Published: November 2020

Abstract

Background
Anaemia and iron deficiency (ID) are both common and associated with adverse outcomes in patients with heart failure (HF). However, the incidence of and recovery from anaemia and ID and their impact on prognosis are not well described.

Methods
Between 2001 and 2018, patients with suspected HF referred to a clinic serving a local population of ∼500,000 were invited to be enrolled in a long-term registry. HF was defined as relevant symptoms or signs with either at least moderate systolic dysfunction on echocardiography or raised plasma concentration of amino-terminal pro-B type natriuretic peptide (NT-proBNP ≥125pg/ml). ID was defined as a transferrin saturation (TSAT) of &lt;20%, anaemia was defined as a haemoglobin (Hb) of &lt;13.0 g/dL in men and &lt;12.0 g/dL in women. At 1-year follow-up, 872 patients had repeat assessments for ID. Patients were grouped into four phenotypes according to the presence or absence of anaemia and/or ID. Those who developed or recovered from ID and anaemia were assessed separately. Survival analysis was conducted at 5 years after the one-year visit.

Results
The prevalence of ID and anaemia at baseline was 40% and 29% respectively. At baseline and at one-year, 53% of patients had either ID, anaemia or both. Compared to other groups, those with both anaemia and ID were older, had worse renal function and higher median NT-proBNP. In patients with TSAT &gt;20% without anaemia at baseline, 23% had ID at 1 year, 14% were anaemic and 6% developed both. At one year, 11% of patients with anaemia and ID at baseline had normal values for both compared to 16% of those with anaemia but not ID. In patients with ID without anaemia at baseline, 51% remained iron deficient at one year, irrespective of initial Hb.
At 5-years, survival was markedly worse for those with anaemia at baseline compared to those without anaemia, irrespective of iron status. Compared to those who had normal TSATs and Hb, those with both anaemia and ID had the worst survival (HR=2.35; 1.77–3.11; p&lt;0.001), followed by those with anaemia without ID (HR=1.93; 1.40–2.67; p&lt;0.001) and those with isolated ID (HR=1.34; 1.01–1.78; p=0.046).
Compared to patients who never had anaemia or ID, patients who developed (HR 2.01; 1.41–2.88; p&lt;0.001) or recovered from (HR 2.21; 1.45–3.39; p&lt;0.001) anaemia or ID (HR 1.61; 1.14–2.28; 0.007 and HR 1.63; 1.16–2.28; 0.005 respectively) had a worse prognosis.

Conclusions
About 30% of patients with HF who have neither anaemia nor ID will develop such problems within a year and this associated with a worse prognosis. Recovery from ID and anaemia is also common, but this is not associated with a better prognosis. Factors leading to the development of anaemia and ID may be driving prognosis rather than anaemia and ID themselves

Funding Acknowledgement
Type of funding source: None
Comparative prognostic impact of ACCI and AHEAD risk score in heart failure with reduced, mid-range and preserved left ventricular ejection fraction admitted for acute decompensated heart failure
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

Abstract

Background
Comorbidities are strongly associated with poor clinical outcome in heart failure patients (pts). 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 pts. On the other hand, AHEAD risk score has been recently reported as a useful long-term risk stratification score in acute decompensated heart failure (ADHF) pts. Recently, a new group of heart failure pts with mid-range ejection fraction (HFmrEF) has been defined, separated from reduced ejection fraction (HFrEF) and preserved ejection fraction (HFpEF). We sought to compare the prognostic value of ACCI and AHEAD score in ADHF pts, relating to HFrEF, HFmrEF and HFpEF.

Methods
We prospectively studied 410 consecutive ADHF pts (HFrEF [n=143], HFmrEF [n=99] and HFpEF [n=168]) with survival discharge. ACCI contains 19 issues which was weighted according to their potential influence on mortality. AHEAD risk score is a simple index, which is range 0–5; atrial fibrillation, hemoglobin &lt;13 mg/dL for men and 12 mg/dL for women, age &gt;70 years, creatinine &gt;130 μmol/L, and diabetes mellitus. The endpoint of this study was all cause death (ACD).

Results
During a follow-up period of 2.4±1.4 years, 119 pts had ACD (42, 29 and 48 pts in HFrEF, HFmrEF and HFpEF, respectively). At univariate Cox analysis, ACCI and AHEAD risk score were significantly associated with ACD in each subgroup. At multivariate Cox analysis, in HFrEF pts, ACCI, but not AHEAD risk score, showed the significant and independent association with ACD. In HFmrEF, both ACCI and AHEAD risk score was significantly and independently associated with ACD and ROC analysis showed AUC of ACCI was greater than that of AHEAD risk score (0.778 [0.683–0.855] vs 0.637 [0.572–0.764], p=0.07). On the other hand, in HFpEF pts, AHEAD risk score, but not ACCI, showed the significant and independent association ACD.

Conclusion
ACCI provides more prognostic value in HFrEF pts, and AHEAD risk score has more prognostic value in HFpEF pts. In HFmrEF pts, both ACCI and AHEAD score might have prognostic values, although ACCI tends to be more associated with ACD than AHEAD score.

Funding Acknowledgement
Type of funding source: None
Is hypocapnia a risk factor for non-invasive ventilation failure in acute heart failure?
Authors: Carrillo-Aleman L , Montenegto Moure A , Lopez Gomez L , Bayoumi Delis P.S , Agamez Luengas A.A , Higon Canigral A , Casado Mansilla D , Carrasco Gonzalez E , Tornero Yepez P , Martinez Perez V , Carrillo Alcaraz A 
Published: November 2020

Abstract

Introduction
Non-invasive ventilation (NIV) has become a standard treatment for acute respiratory failure. Multiple factors associated with failure of this ventilatory technique have been described. Some authors postulate that the presence of hypocapnia at the onset of NIV increases the mortality of patients with acute heart failure (AHF).

Purpose
To analyse whether the presence of hypocapnia is a risk factor for failure of NIV in the patient with AHF.

Methods
Observational, retrospective study on a prospective database. All patients with AHF admitted to Intensitive Care Unit (ICU) between January 1997 and December 2017 for respiratory failure and requiring NIV are included. The inclusion criteria were the presence of dyspnea, respiratory rate ≥30 and PaO2/FiO2 &lt;250 mmHg. The exclusion criteria were the presence of cardiogenic shock and AHF due to involvement of the right ventricle. Hypocapnia is defined as the presence of PaCO2 &lt;35 mmHg) in basal gasometry prior to NIV, normocapnia as PaCO2 between 35 and 45 mmHg and PaCO2 hypercapnia greater than 45 mmHg. NIV failure is defined as the need for endotracheal intubation or death in ICU. Quantitative variables are expressed as means ± standard deviation, and qualitative variables as percentages. Comparison between variables has been made using the Ji2 linear trend test and single factor ANOVA. Multivariate analysis was performed using logistic regression with the calculation of odds ratios (OR) and their 95% confidence intervals (CI-95%).

Results
A total of 1009 patients with AHF, 158 (15.7%) normocapnic, 361 (35.8%) hypocapnic and 490 (48.5%) hypercapnic were analyzed. The age in the 3 groups was 73.3±10.4, 73.3±11.2 and 75.6±8.9 years (p=0.001), respectively. In the normocapnic group the respiratory rate was 36±4, PaCO2 40±3 and PaO2/FiO2 125±31. In the hypocapnic group 37±3, 28±3 and 134±30; and in the hypercapnic group 37±6, 65±16 and 126±36, respectively. NIV failure was observed in 15 (9.5%) of normocapnic patients, 56 (15.5%) of hypocapnic patients and 54 (11%) of hypercapnic patients (p=0.070). Independent risk factors for NIV failure were SAPS II (OR=1.07, CI-95%=1.04–1.09), order of non-intubation (OR=2.88, CI-95%=1.45–1.81), baseline SOFA (OR=1.76, CI-95%=1.48–2.08), HACOR index at 1 hour NIV (OR=1,62, CI-95%=1.45–1.08), the presence of acute coronary syndrome (OR=2.18, CI-95%=1.18–4.01), the presence of NIV-related complication (OR=6.42, CI-95%=3.47–11.89) and hypocapnia at the onset of NIV (OR=3.842, CI-95%=2.02–7.27).

Conclusions
Hypocapnia at the beginning of NIV in the patient with AHF is a frequent finding. Among the risk factors for poor prognosis, the presence of hypocapnia is a strong predictor of NIV failure.

Funding Acknowledgement
Type of funding source: None
Ischemic heart disease is more prevalent in low-income-countries and more often undertreated: data from report-hf
Authors: Tromp J , Bamadhaj S , Cleland J.G.F , Angermann C.E , Dahlstrom U , Ertl G , Hassanein M , Perrone S.V , Ghadanfar M , Schweizer A , Obergfell A , Collins S.P , Filipatos G.F , Lam C.S.P , Dickstein K 
Published: November 2020

Abstract

Background
The pathogenic role of ischemic heart disease (IHD) in heart failure is well known. However, little is known about the global differences in the prognostic significance and treatment patterns of IHD in acute heart failure (AHF).

Methods
We prospectively enrolled 18,553 patients with AHF from 44 countries and 365 centers in the REPORT-HF registry. Patients with a history of coronary artery disease, an ischemic etiology of the AHF event or coronary revascularization were classified as IHD. Differences in clinical characteristics, treatment and outcome were analyzed.

Results
Compared to 9,344 (50%) patients without IHD, the 9,189 (50%) patients with IHD were older, more often had a left ventricular ejection fraction [LVEF] &lt;40%, (HFrEF) and decompensated chronic HF (DCHF) and had a greater comorbidity burden. Despite patients from lower-income countries having a higher prevalence of IHD (55% vs. 45% in high-income countries), only 27% of patients with IHD from low-income countries were treated with medicines commonly prescribed for HF (Figure A) compared to 16% of patients with IHD from high income countries. After correction for clinical confounders and medication use, patients with IHD had a shorter “door-to-nitrates and -diuretics time” and worse 1-year mortality (hazard ratio: 1.18, 95% CI: 1.09, 1.27, Figure B) irrespective of geographic region (Pinteraction &gt;0.1). We found a significant interaction for prognosis (Pinteraction &lt;0.001) between IHD and HF diagnosis (DCHF vs. new-onset HF) as well as HF subtype (HFrEF vs. HF with preserved ejection fraction) respectively, such that IHD conveyed worse outcomes in patients with new-onset HF and HFrEF respectively in all world regions.

Conclusion
In this large global contemporary cohort of patients with AHF, IHD was more common in patients from low income countries, conveyed worse 1-year mortality, particularly in patients with new onset HF and patients with HFrEF. Despite worse outcomes, patients in regions with the greatest burden of IHD were more often undertreated.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis
Change in high-sensitivity troponin t levels and 1-year outcomes in patients with acute heart failure: China PEACE prospective heart failure study
Authors: Li J , Zhang L , Wu C 
Published: November 2020

Abstract

Background
High-sensitivity cardiac troponin T (hs-cTnT) is an important prognostic marker in heart failure (HF). However, it is unclear whether the change of hs-cTnT levels can predict long-term clinical outcomes in patients with acute HF.

Purpose
To examine the association between change in hs-cTnT from hospital admission to 1-month after discharge and subsequent 1-year cardiovascular death or HF hospitalization in patients with acute HF.

Methods
We included patients hospitalized primarily for HF from 52 hospitals in China, who had central analysis of hs-cTnT at both admission and 1-month after discharge. Change in hs-cTnT was calculated as hs-cTnT level at 1-month minors that at admission. The composite outcome measure was cardiovascular death or HF hospitalization within 1 year after discharge. We tested the linearity assumption between change in hs-cTnT level and the composite events using restricted cubic splines. To further explore the quantitative association between change in hs-cTNT and the events, we also applied a Cox proportional hazards model using change in hs-cTNT as a continuous variable, adjusting for hs-cTnT level at admission (log transformed) and known prognostic variables.

Results
We included 2355 patients hospitalized primarily for HF. Median change in hs-cTnT from baseline was −2.7ng/L (IQR −9 to 0.7). 614 (26.1%) patients experienced the events of cardiovascular death or HF hospitalization within 1 year. Among patients with hs-cTnT &lt;14ng/L (the upper limit of the reference value) at admission, patients had low risk of the events regardless whether hs-cTNT ≥14ng/L at 1-month or not (20.2% vs. 14.1%, p=0.11). Among patients with hs-cTnT ≥14ng/L at admission, patients with hs-cTNT ≥14ng/L at 1-month had higher risk of the events than those with hs-cTnT &lt;14ng/L (36.4% vs. 18.6%, p&lt;0.0001). The association between change in hs-cTnT and the events was non-linear. When change in hs-cTnT was &lt;4ng/L and &gt;−4ng/L, per 1 ng/L decrease was associated with a 7% reduction in risk of the events [hazard ratio (HR) 0.93, 95% CI 0.88–0.99]. When change in hs-cTnT was &lt;−4ng/L, there was a levelling off in the reduced risk (HR: 0.99, 95% CI 0.99–1.00). While change in hs-cTnT was &gt;4ng/L, it was not significantly associated with the events any longer (Figure 1).

Conclusion
Among patients hospitalized for HF, changes in hs-cTnT from admission to 1 month can predict the risk of cardiovascular death and HF hospitalization.

Funding Acknowledgement
Type of funding source: Other. Main funding source(s): The National Key Research and Development Program from the Ministry of Science and Technology of China; the CAMS Innovation Fund for Medical Science; the 111 Project from the Ministry of Education of China
Serial echocardiographical assessment for urgent control of rapid atrial fibrillation in acute heart failure
Authors: Iwahashi N , Kirigaya J , Horii M , Hanajima Y , Abe T , Akiyama E , Okada K , Matsuzawa Y , Maejima N , Hibi K , Kosuge M , Ebina T , Tamura K , Kimura K 
Published: November 2020

Abstract

Objectives
Doppler echocardiography is a well-recognized technique for noninvasive evaluation; however, little is known about its efficacy in patients with rapid atrial fibrillation (AF) accompanied by acute decompensated heart failure (ADHF). The aim of this study was to explore the usefulness of serial echocardiographical assessment for rapid AF patients with ADHF.

Patients
A total of 110 ADHF patients with reduced ejection fraction (HFrEF) and rapid AF who were admitted to the CCU unit and received landiolol treatmentto decrease the heart rate (HR) to &lt;110 bpm and change HR (ΔHR) of &gt;20% within 24 hours were enrolled.

Interventions
Immediately after admission, the patients (n=110) received landiolol, and its dose was increased to the maximum; then, we repeatedly performed echocardiography. Among them, 39 patients were monitored using invasive right heart catheterization (RHC) simultaneously with echocardiography.

Measurements and main results
There were significant relationships between Doppler and RHC parameters through the landiolol treatment (Figure, baseline–max HR treatment). We observed for the major adverse events (MAE) during initial hospitalization, which included cardiac death, HF prolongation (required intravenous treatment at 30 days), and worsening renal function (WRF). MAE occurred in 44 patients, and logistic regression analyses showed that the mean left atrial pressure (mLAP)-Doppler (odds ratio = 1.132, 95% confidence interval [CI]: 1.05–1.23, p=0.0004) and stroke volume (SV)-Doppler (odds ratio = 0.93, 95% confidence interval [CI]: 0.89–0.97, p=0.001) at 24 hours were the significant predictors for MAE, and multivariate analysis showed that mLAP-Doppler was the strongest predictor (odds ratio = 1.16, 95% CI: 0.107–1.27, p=0.0005) (Table).

Conclusions
During the control of the rapid AF in HFrEF patients withADHF, echocardiography was useful to assess their hemodynamic condition, even at bedside.
Doppler for rapid AF of ADHF

Funding Acknowledgement
Type of funding source: None