bluuebunny/crossref_metadata_2025_split huggingface dataset:
The role of cardiac surgery in transvenous lead extraction (TLE) – experience from high volume center and 3207 procedures
Authors: Tulecki L , Czajkowski M , Targonska S , Tomkow K , Nowosielecka D , Jachec W , Polewczyk A , Stazka J , Kutarski A 
Published: November 2020

Abstract

Background
The guidelines suggest close co-operation between TLE operating team and cardiac surgery and its key role in the management of life-threatening complications remains unquestionable. But the role of cardiac surgeon seems to be much more extended.

Purpose
We have analysed the role of cardiac surgery in treatment of patients undergoing TLE procedures.

Methods
Using standard non-powered mechanical systems we have extracted ingrown PM/ICD leads from 3207 pts (38,7% female, average age 65,7-y) during the last 14 years. Non-infectious TLE indications were in 66,4% of patients. 46% had PM DDD system, 19% PM SSI, 22% ICD, 9% CRT, 4% other systems. In 12% of patients abandoned leads were found. 8% of patients had one lead, 54% - two, 15% - three and 4% - 4–6 leads in the heart. An average dwell time of all leads was 91,5 mth. The lead entry side was left in 96% of patients, right in 3% and both – 4%.

Results
Procedural success 96,1%, clinical success - 97,8%, procedure-related death 0,2%. Major complications appeared in 1,9% (cardiac tamponade 1,2%, haemothorax 0,2%, tricuspid valve damage 0,3%, stroke, pulmonary embolism &lt;1%).

Conclusions
Rescue cardiac surgery (for severe haemorrhagic complications) is still the most frequent reason of surgical intervention (1,1%). The second area of co-operation includes supplementary cardiac surgery after (incomplete) TLE (0,8%). The third one is connected with reconstruction or replacement of tricuspid valve, which can be affected by ingrown lead or damaged during TLE procedure (0,5%). Implantation of the complete epicardial system during any surgical intervention (rescue or delayed) should be considered as a supplementation of the operation (0,65%). Some of patients after TLE need implantation of epicardial leads for permanent epicardial pacing (0,6%) and some only left ventricular lead to rebuild permanent cardiac resynchronisation (0,5%). The single experience of large TLE centre indicates the necessity of close co-operation with cardiac surgeon, whose role seems to be more comprehensive than a surgical stand-by itself.
Table 1

Funding Acknowledgement
Type of funding source: None
Transvenous removal of pacing and ICD leads: single italian referral center experience
Authors: Segreti L , Giannotti Santoro M , Di Cori A , Fiorentini F , Zucchelli G , De Lucia R , Viani S , Paperini L , Barletta V , Soldati E , Bongiorni M.G 
Published: November 2020

Abstract

Introduction
Device related complications are rising the need of Transvenous Lead Removal (TLR). Transvenous extraction of Pacing (PL) and Defibrillating Leads (DL) is a highly effective technique. Aim of this report is to analyse the longstanding experience performed in a single Italian Referral Center.

Methods
Since January 1997 to December 2019, we managed 2769 consecutive patients (2100 men, mean age 65.5 years) with 5086 leads (mean pacing period 73.6 months, range 1–576). PL were 3998 (1828 ventricular, 1704 atrial, 466 coronary sinus leads), DL were 1088 (1067 ventricular, 6 atrial, 15 superior vena cava leads). Indications to TLR were infection in 79% (systemic 27%, local 52%) of leads. We performed mechanical dilatation using a single polypropylene sheath technique and if necessary, other intravascular tools; an Approach through the Internal Jugular Vein (JA) was performed in case of free-floating leads or failure of the standard approach.

Results
Removal was attempted in 5076 leads because the technique was not applicable in 10 PL. Among these, 4952 leads were completely removed (97.6%), 49 (1.0%) partially removed, 75 (1.4%) not removed. Among 4989 exposed leads, 818 were removed by manual traction (16.4%), 3664 by mechanical dilatation using the venous entry site (73.4%), 48 by femoral approach (FA) (1.0%) and 335 by JA (6.7%). All the free-floating leads were completely removed, 25.3% by FA and 74.7% by JA. Major complications occurred in 20 cases (0.72%): cardiac tamponade (19 cases, 4 deaths), hemotorax (1 death).

Conclusions
Our experience shows that in centers with wide experience, TLR using single sheath mechanical dilatation has a high success rate and a very low incidence of serious complications. TLR through the Internal Jugular Vein increases the effectiveness and safety of the procedure also in case of free-floating or challenging leads.

Funding Acknowledgement
Type of funding source: None
The prevalence and prognosis of tricuspid regurgitation in stage A to C heart failure with preserved ejection fraction
Authors: Ren Q.W , Chen Y , Wu M.Z , Yu Y.J , Yiu K.H 
Published: November 2020

Abstract

Background
Previous studies have demonstrated that the presence of moderate and severe degree of tricuspid regurgitation (TR) is associated with adverse outcome in patients with heart failure with reduced ejection fraction. However, little is known about the prevalence and prognostic value of TR in patients with stage A, B and C heart failure with preserved ejection fraction (HFpEF).

Purpose
The aims of this study is to investigate the prevalence and prognostic value of TR in patients with stage A, B and C HFpEF.

Methods
A total of 2882 patients with stage A (n=904), B (n=1305) and C (n=673) HFpEF from 2013 to 2017 were enrolled. Detailed transthoracic echocardiogram was performed and the severity of TR was graded according to the latest recommendation. Patients were prospectively followed up at our heart failure clinic.

Results
The average age of the study population was 65 and 47% were male. Hypertension was presence in 58% and diabetes in 33% and the mean left ventricular ejection fraction was 62%. The prevalence of moderate and severe TR increased from stage A to C heart failure (HF) (4.2%, 5.9% and 16.5%, respectively, P&lt;0.01). Kaplan-Meier curve revealed that the presence of moderate and severe degree of TR was associated with all-cause mortality and heart failure hospitalization (Log-rank test P&lt;0.01) (Figure). Multivariable analysis demonstrated that moderate (hazard ratio=1.57, P&lt;0.01) and severe TR (hazard ratio=2.53, P&lt;0.01) was associated with mortality and heart failure hospitalization after adjusting for age, gender, ejection fraction, atrial fibrillation and HF stage.

Conclusions
The presence of moderate and severe TR is not uncommon in patients with stage A, B and C HFpEF. Importantly, moderate and severe TR was independently associated with mortality and heart failure hospitalization.
Kaplan-Meier curve for the impact of TR

Funding Acknowledgement
Type of funding source: None
Correlation of coronary microvascular function and diastolic dysfunction
Authors: Kim I.C , Hwang J , Lee C.H , Cho Y.K , Park H.S , Chung J.W , Yoon H.J , Kim H , Han S , Hur S.H , Koo B.K , Doh J.H , Shin E.S , Lee J.M , Nam C.W 
Published: November 2020

Abstract

Background
Coronary microvascular dysfunction (CMD) is an important mechanism for heart failure with preserved ejection fraction (HFpEF) which is closely related with diastolic dysfunction on transthoracic echocardiography (TTE).

Purpose
The aim of this study was to evaluate the association of CMD with echocardiographic parameters of diastolic dysfunction.

Methods
Total 385 patients with chest discomfort in the absence of significant coronary artery obstruction were enrolled to this study and underwent invasive coronary physiologic assessment including index of microcirculatory resistance (IMR), and coronary flow reserve (CFR). Echocardiographic parameters for diastolic dysfunction - left atrial volume index (LAVI) and left ventricular filling pressure (E over e') were compared in patients with true CMD (CFR&lt;2.5 with IMR ≥20), mismatched CMD (CFR≥2.5 with IMR ≥20 or CFR&lt;2.5 with IMR &lt;20), and no CMD (CFR≥2.5 with IMR &lt;20).

Results
Among the study population, 55 patients (14.3%) were true CMD, 162 patients (42.1%) were mismatched CMD and 168 patients (43.6%) were no CMD. Age (62.9±10.5 vs. 61.1±9.9 vs. 61.7±10.5, p=0.522) and left ventricular ejection fraction (63.9±8.1 vs. 63.9±6.2 vs. 63.0±6.7, p=0.414) was not different between groups. Patients with true CMD showed significantly larger left atrial size (LAVI: 34.7±18.2 mL/m2 vs. 26.8±10.7 mL/m2, p=0.005) and trend towards higher LV filling pressure (E/e': 10.8±3.5 vs. 9.9±3.5, p=0.073) compared with no CMD. In subgroup analysis, younger patients showed more pronounced increase of LAVI (Age &lt;65: 39.6±22.6 vs. 26.1±11.6, p=0.003; Age ≥65: 28.0±9.13 vs. 28.8±8.2, p=0.266; p for interaction 0.043) in true CMD compared to no CMD. Non-diabetic patients also showed more pronounced increase of E/e' in true CMD (Non-diabetes: 10.2±2.7 vs. 9.2±2.6, p=0.002; Diabetes: 12.1±4.5 vs. 11.9±5.1, p=0.197; p for interaction 0.015).

Conclusions
Coronary microvascular dysfunction is significantly related with echocardiographic parameters of diastolic dysfunction. The effect of CMD on diastolic dysfunction is more prominent in low-risk patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Effect of infarct stiffness on non-infarcted left and right ventricular tissue remodeling: a computational study based on myocardial mechano-transduction
Authors: Koopsen T , Van Osta N , Willemen E , Van Nieuwenhoven F.A , Gorcsan J , Prinzen F.W , Arts T , Delhaas T , Lumens J 
Published: November 2020

Abstract

Background/Introduction
The mechanical properties of infarcted myocardium are important determinants of cardiac pump function and risk of developing heart failure following myocardial infarction (MI).

Purpose
To better understand the effects of infarct stiffness on compensatory hypertrophy and dilation of non-infarcted tissue in the left (LV) and right ventricle (RV), by using a computational model.

Methods
The CircAdapt computational model of the human heart and circulation was applied to simulate an acute MI involving 20% of LV wall mass. The simulation was validated using previously published experimental data. Subsequently, two degrees of increased infarct stiffness were simulated. In all three simulations, a model of structural myocardial adaptation of the non-infarcted tissue was applied, based on sensing of mechanical loading of myocytes and extracellular matrix (ECM).

Results
Mild and severe stiffening of the infarct reduced the increase of LV end-diastolic volume (EDV) from +23 mL to +17 mL and +16 mL, respectively, and the increase of LV non-infarcted tissue mass from +31% to +21% and +18%. RV EDV decreased after adaptation, and mild and severe infarct stiffening reduced the decrease of RV EDV from −21 mL to −12 mL and −10 mL, respectively. Increase of RV tissue mass was reduced from +13% to +8% and +7% with mild and severe infarct stiffening. In the LV, reduced dilation and hypertrophy were driven mainly by a reduction of maximum stress in the ECM and a higher stress between the myocytes and ECM following infarct stiffening. The decreased RV hypertrophy, but not EDV reduction, was caused by a reduction of maximum RV ECM stress and maximum RV active myofiber stress.

Conclusions
Model simulations predicted that a stiffened LV infarct reduces both LV and RV non-infarcted tissue hypertrophy as well as LV dilation. In LV remodeling, maximum ECM stress and stress between myocyte and ECM played a more prominent role than in RV remodeling, while maximum active stress was more important in the RV.
Overview of all model simulations

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): This work was funded by the Netherlands Organisation for Scientific Research and the Dutch Heart Foundation.
Neutrophil neprilysin expression correlates with inflammatory activation in chronic HFrEF patients
Authors: Prausmueller S , Pavo N , Stasek S , Arfsten H , Spinka G , Goliasch G , Bartko P.E , Huelsmann M 
Published: November 2020

Abstract

Background
Inhibition of neprilysin by the angiotensin receptor-neprilysin inhibitor has shown remarkable success in the treatment of heart failure with reduced ejection fraction (HFrEF). However, the exact mechanism of action is still a matter of debate. Neprilysin (NEP) is a ubiquitous transmembrane endopeptidase markedly expressed on the cell surface of neutrophils, in this context also known as CD10. Originally, CD10 has been identified as a cell surface marker to discriminate mature from immature neutrophils. Other inflammatory neutrophil surface markers such as CD11b, CD64 and CD66b are commonly used to determine the activation status of neutrophils. In our previous explorative study, NEP expression on neutrophils correlated inversely with HF severity and mortality. This study aimed to explore the relationship between NEP expression and typical neutrophil activation markers and to confirm its relation to HF severity reflected by NT-proBNP and NYHA class in a bigger cohort of HFrEF patients.

Methods
We prospectively enrolled 208 consecutive patients with stable HFrEF. Mean fluorescence intensity (MFI) of CD10 expression on peripheral blood neutrophils was determined by flow cytometry of whole blood samples. In addition, for a subset of 117 patients the expression of CD11b, CD64 and CD66b was measured. EDTA anticoagulated blood (100 μl) was stained using a combination of six antibodies with fluorescence minus one sample as control [CD10 (#332777), CD45 (#560178), CD16 (#335035), CD11b (#555388), CD64 (#561191), CD66b (#562254); BD Biosciences, San Jose, CA, USA].

Results
Median age was 64 years (IQR 54–72), 57 (27%) patients were female. Median NT-proBNP values were 1819 pg/ml (IQR 740–4264). Approximately half of the study population with 115 (55.3%) patients had a non-ischemic etiology of HF. Median MFI of NEP (CD10) on neutrophils was 5542 (IQR 4168–6903). Neutrophil NEP expression decreased with HF severity reflected by NYHA stage (p=0.006) and tertiles of NT-proBNP (p=0.003). Interestingly, non-ischemic HFrEF was characterized by higher neutrophil NEP expression compared to ischemic HFrEF [5703 (IQR 4548–7235) vs 4994 (IQR 3844–6718), p=0.018]. Neutrophil NEP expression correlated highly significant with CD11b expression (r=0.61, p&lt;0.001) but not with CD64 and CD66b [p=ns] (Figure 1).

Conclusion
These data support the evidence for an inverse correlation of neutrophil NEP expression with HF severity in stable HFrEF patients and for NEP upregulation on neutrophils in patients with non-ischemic cardiomyopathy. There was a strong relationship between neutrophil NEP regulation and the activation marker CD11b, proposing a link between the neutrophil NEP compartment and systemic inflammatory response.
Figure 1

Funding Acknowledgement
Type of funding source: None
Prevalence and prognostic impact of somatic mutations in patients with heart failure and reduced ejection fraction
Authors: Vazquez Andres D.J , Hernandez Vicente A , Diez Diez M , Gomez Molina M , Quintas A , Vazquez E , Dopazo A , Asensio Lopez M.C , Lax A , Sanchez Perez M.C , Fer E , De La Barrera J , Sanchez Cabo F , Fuster J.J , Pascual Figal D.A 
Published: November 2020

Abstract

Introduction
Somatic mutations in hematopoietic cells are associated with age and have been associated with higher mortality in apparently healthy adults, especially due to atherosclerotic disease. In animal models, somatic mutations are associated with atherosclerosis progression and myocardial dysfunction, especially when gene TET2 is affected. Preliminary clinical data, referred to ischemic heart failure (HF), have associate the presence of these acquired mutations with impaired prognosis.

Purpose
To study the prevalence of somatic mutations in patients with heart failure with reduced ejection fraction (HFrEF) and their impact on long-term prognosis.

Methods
We studied a cohort of elderly patients (more than 60 years old) hospitalized with HFrEF (LVEF&lt;45%). The presence of somatic mutations was assessed using next generation sequencing (Illumina HiSeq 2500), with a mutated allelic fraction of at least 2% and a panel of 55 genes related with clonal hematopoiesis. Patients were followed-up for a median of three years. The study endpoint was a composite of death or readmission for worsening HF. Kaplan-Meier analysis (log-rank test) and Cox proportional hazards regression models were performed adjusting for age, sex and LVEF.

Results
A total of 62 patients (46 males (74.2%), age 74±7.5 years) with HFrEF (LVEF 29.7±7.8%) were enrolled in the study. The ischemic etiology was present in 54% of patients. Somatic mutations in Dnmt3a or Tet2 were present in 11 patients (17.7%). No differences existed in baseline characteristics except for a higher prevalence of atrial fibrillation in patients with somatic mutations (70% vs. 40%, p=0.007). During the follow-up period, 40 patients (64.5%) died and 38 (61.3%) had HF re-admission. The KM survival analysis for the combined event is shown in Figure 1. Compared with patients without somatic mutations and after adjusting for covariates, there was an increased risk of adverse outcomes when the somatic mutations were present (HR 3.6, 95% CI [1.6, 7.8], p=0.0014). This results remains considering death as a competing risk (Gray's test p=0.0097) and adjusting for covariates (HR = 2.21 95% CI [0.98, 5], p=0.0556).

Conclusions
Somatic mutation are present in patients with HFrEF and determine a higher risk of adverse events in the follow-up. Further studies are needed to assess the clinical implications of these findings.
Figure 1

Funding Acknowledgement
Type of funding source: None
Rehospitalization as a predictor of mortality in Polish population of heart failure patients-national registry
Authors: Zaleska-Kociecka M , Witczak K , Bartolik K , Was D , Kleinork A , Maruszewski B , Brukalo K , Rolska-Wojcik P , Leszek P 
Published: November 2020

Abstract

Background
High mortality risk in heart failure (HF) is related to repeat HF hospitalizations but also individual patient characteristics.

Purpose
To evaluate the impact of HF re-/hospitalizations and patient-related factors (sex, HF etiology, age, comorbidity) on all-cause mortality.

Methods
Our study represents one of the most extensive retrospective cohort analyses consisting of 1,686,861 adult Polish HF patients who presented into public health system in years 2013–2018. It is a part of a nationwide National Health Fund registry covering out- and in-patient data for the entire Polish population (38,495,659 in 2013) since 2009. HF hospitalizations were extracted using ICD-10 coding, whereas the comorbidity was evaluated by means of Charlson Comorbidity Index (CCI).

Results
In years 2013–2018 the absolute number of HF hospitalizations in Poland grew by 33% to 264,808 in 2018, whereas the number of rehospitalizations increased 1.5-fold to reach 137,708 in 2018.
In fact, nearly half of HF patients (n=817,432; 48.5%) experienced at least one hospitalization, while 15.4% (n=259,868) were rehospitalized during the study period. After initial hospitalization the readmission rate due to HF/all circulatory diseases at 30, 60, 180, 360, and 720 days was 10.4%/15.1%, 21.2%/28.3%, 43.9%/52.8%, 62%/70.4%, and 81%/87%, respectively.
As compared to patients who were hospitalized just once, those who underwent at least one rehospitalization were more often female (p&lt;0.001), slightly older (p&lt;0.001), and with higher burden of comorbidities based on CCI (p&lt;0.001).
Patient survival was highly dependent on hospitalization frequency (Fig. 1). Mean survival rate at day 720 was 66.4%, 59.8%, 54.9%, 51%, and 43.9% for 1st, 2nd, 3rd, 4th, and ≥5th hospitalization, respectively.
After adjusting for age, sex, etiology (ischemic/non-ischemic) and CCI using a multivariate stratified Cox regression model, the estimated hazard ratios (HR) for all-cause mortality amounted to 1.22 (95% CI: 1.21–1.23, p&lt;0.001) for 2nd, 1.4 (95% CI: 1.39–1.42, p&lt;0.001) for 3rd, 1.58 (95% CI: 1.56–1.6, p&lt;0.001) for 4th, and 1.97 (95% CI: 1.95–1.98 p&lt;0.001) for 5th and subsequent hospitalizations, as compared to the first hospitalization.

Conclusions
Hospitalization rate in Poland is alarmingly high. Repeat HF hospitalizations strongly predict mortality rate for HF patients even after adjustment for age, sex, etiology, and comorbidity burden.
Figure 1. Kaplan-Meier for survival post hosp.

Funding Acknowledgement
Type of funding source: Public grant(s) – EU funding. Main funding source(s): The project is co-financed by the European Union from the European Social Fund under the Operational Programme Knowledge Education Development and it is being carried out by the Analyses and Strategies Department of the Polish Ministry of Health.
Risk for stroke and systemic embolism in patients with atrial fibrillation and heart failure according to heart failure type
Authors: Uhm J.S , Yu H.T , Kim T.H , Pak H.N , Lee M.H , Joung B 
Published: November 2020

Abstract

Introduction
Risk for stroke and systemic embolism (SE) in patients with atrial fibrillation (AF) and heart failure (HF) with mid-range (mr) ejection fraction (EF) is not well known.

Methods
Total 10,780 patients (age, 66.8±11.1 years; men, 64.7%) with AF were included in a prospective, multicenter AF registry. The patients were grouped into four according to HF type: no-HF, HF with preserved EF (HFpEF), HFmrEF, and HF with reduced EF (HFrEF). Baseline characteristics, cumulative incidence and hazard ratios for stroke/SE, major bleeding, and mortality were compared among the four groups.

Results
Proportion of patients with HF was 10.3%: HFpEF, 43.7%; HFmrEF, 23.6%; HFrEF, 32.7%. CHA2DS2-VASc score was significantly higher in the HFpEF, HFmrEF, and HFrEF groups than the no-HF group (4.0±1.7, 3.8±1.8, 3.5±1.8, and 2.5±1.6, respectively). Oral anticoagulants were administered in 83.6% of patients with CHA2DS2-VASc score ≥1. Annual incidence of stroke/SE was 2.0% in HFpEF group, 0.6% in HFmrEF group, 1.1% in HFrEF group, and 0.7% in no-HF group for 23.0±9.5 months of follow-up period. Cumulative incidence of stroke/SE was significantly higher in the HFpEF group than the no-HF and HFmrEF groups (p&lt;0.001 and p=0.042, respectively; Figure). Risk for stroke/SE was significantly higher in the HFpEF group than the no-HF group [hazard ratio, 1.929; 95% confidence interval, 1.171–3.179, p=0.010]. There were no significant differences in risk for stroke/SE in the HFmrEF and HFrEF groups, compared with the no-HF group. There were no significant differences in major bleeding and mortality among the groups.

Conclusions
Risk for stroke/SE is highest in HFpEF and lowest in HFmrEF in patients with AF and HF.
Figure 1

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Research Foundation of Korea