bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of enalapril on left ventricular longitudinal strain in patients with hematologic malignancies after bone marrow transplantation
Authors: Katogiannis K , Ikonomidis I , Stamouli M , Makavos G , Frogoudaki A , Vrettou A.R , Birba D , Thymis I , Tsilivarakis D , Liori S , Tsirigotis P , Iliodromitis E.K 
Published: November 2020

Abstract

Background and aims
Chemotherapy is known for its potential adverse effects on myocardium. Optimal medical treatment for heart failure may reverse myocardial dysfunction in the early stages of toxicity development. We hypothesized that early initiation of treatment with Angiotensin Converter Enzyme inhibitor (ACE-i) enalapril could prevent cardiotoxicity.

Patients and methods
60 patients (mean age 46,3±12,9 years old, 19 male) with preserved ejection fraction, who suffered from hematologic malignancies (lymphoma, leukemia) and underwent bone marrow transplantation and were randomized to receive 2,5 mg enalapril bid daily or placebo. We measured at baseline, before transplantation, and after three months: i) Global Longitudinal Strain of left ventricle (LV) (GLS), ii) Left Ventricular Epicardial Strain (GLSepi), iii) Left Ventricular Endocardial Strain GLSendo), by speckle tracking imagind iv) Left Ventricular End Diastolic Volume, Left Ventricular End Systolic Volume and Left Ventricular Ejection Fraction (LVEF-Simpson's Method).

Results
The two treatment groups had similar age, sex atherosclerotic risk factors and cardiotoxic medication befeor and after bone marroe transplantation. Compared to baseline, patients treated with enalapril did not show a deterioration of LV GLS and GLSepi [(GLS = −20.2±3.6% vs 19.7±3.7%, p=0.540), (GLSepi = −17.9±3.1% vs −17.2±3.2%, p=0.422)], Conversely, patients treated with placebo group, presented a significant impairment of LV GLS and GLSepi [(GLS = −20.2±1.8% vs 18.9±2.1%, p=0.041, GLSepi = −17.8±1.5% vs −16.6±1.7%, p=0.028)] three months after bone marrow transplantation. No significant changes were found in LVEF after treatment with enalapril (58.6±17.6% vs 59.4±9.2%, p=0.692) or the placebo (59.4±6.6% vs 59.7±6.8%, p=0.892).

Conclusions
Treatment with enalapril prevented deterioration of myocardial deformation three months after bone marrow transplantation in patients with hematologic malignancies and preserved ejection fraction.

Funding Acknowledgement
Type of funding source: None
The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma
Authors: Vahabi S , Kharati-Koopaei E , Stewart M , Hancock H , Norouzi M , Maddox J , Austin D 
Published: November 2020

Abstract

Background
Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected.

Purpose
To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF &lt;53%), and Group 2 (G2) without.

Methods
We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139).

Results
Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups.

Conclusion
In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity.

Funding Acknowledgement
Type of funding source: None
Severity and type of lymphoma are associated with aortic 18-fluorodeoxyglucose (FDG) positron emission tomographic uptake assessed by FDG PET/CT imaging
Authors: Koutagiar I , Georgakopoulos A , Pouli A , Sioni A , Giannouli S , Solomou E , Terentes-Printzios D , Karakitsios I , Kafouris P , Gaitanis A , Petrocheilou A , Pianou N , Tousoulis D , Vlachopoulos C , Anagnostopoulos C 
Published: November 2020

Abstract

Introduction
There is increasing evidence that metabolic disease burden in lymphoma influence patients' outcome.However, the impact of disease severity on cardiovascular system remains unknown.

Purpose
To assess whether lymphoma is associated with arterial inflammation by examining the relationship between disease metabolic burden and arterial fluorodeoxyglucose (FDG) uptake.

Methods
Sixty-two patients (43 male, mean age 58±18 years) with Hodgkin (n=29) or non-Hodgkin lymphoma (n=33) before chemotherapy and two separate control groups of 14 and 16 healthy individuals for Hodgkin and non-Hodgkin population respectively, with similar age, sex and cardiovascular risk factors,underwent FDG position emission tomography (FDG-PET/CT) imaging.Disease severity was quantified by metabolic tumor volume (MTV) and total lesion glycolysis (TLG) corresponding to standard uptake values (SUV) ≥41% or ≥2.5 of maximum SUV within lymphoma regions, and aortic FDG uptake by target-to-background ratio (TBR). Serum high sensitivity-C-reactive protein (hs-CRP), white blood count (WBC), ratio of neutrophils to lymphocytes (N/L), albumin and lactic acid dehydrogenase (LDH) values were measured for patient group.

Results
MTV and TLG measurements correlated significantly with hs-CRP, WBC,N/L ratio,albumin and LDH table 1.Patients with non-Hodgkin or Hodgkin lymphoma had increased aortic TBR compared to controls (p=0.001 and p=0.023, respectively).Aortic TBR was higher in patients with stage III-IV disease compared to those with stage I-I (p=0.046).There were significant associations between aortic FDG uptake and MTV values, which remained significant after adjustment for confounders (β=0.353, p=0.001, adjusted R2=0.318 for MTV41%, β=0.442, p=0.001, adjusted R2=0.269 for MTV2.5), Figure 1.

Conclusions
Aortic wall FDG uptake is related with disease severity indicating a vascular effect of lymphoma, as well as a new potential role of molecular imaging in cardio-oncology for evaluating disease severity and its consequences to vascular beds with a single examination.
Figure 1

Funding Acknowledgement
Type of funding source: None
Neoplastic markers in Takotsubo syndrome. Results from a prospective registry
Authors: Santoro F , Mallardi A , Leopizzi A , Vitale E , Zimotti T , Ieva R , Iacoviello M , Brunetti N.D 
Published: November 2020

Abstract

Background
Takotsubo syndrome (TTS) is an acute heart failure syndrome with significant rate of in and out-of hospital mayor cardiac adverse events (MACE).

Aim of this study
Evaluate the possible role of neoplastic biomarkers (CA 15.3, CA-19.9 and Carcinoembryonic Antigen (CEA)) as prognostic marker at short- and long-term follow-up in subjects with TTS.

Methods
Ninety consecutive subjects with TTC were enrolled and followed for a median of 3 years. Circulating levels of CA-15.3, CA-19.9, CEA were evaluated at admission, after 72 h and at discharge. Incidence of MACE during hospitalization and follow-up were recorded.

Results
Forty-three (46%) patients experienced MACE during hospitalization. These patients were older (78±9 vs 72±12 p=0.01), had lower LVEF (32±7 vs 38±8 p=0,01) and increased levels of CEA (4.3±6.2 vs 2.2±1.5 ng/ml p=0.03). CEA and CA 19.9 levels at admission were statistically correlated with CRP and NT-proBNP levels (both p&lt;0.05).
At long term follow-up CEA and CA 19.9 levels (higher than median) were associated with increased risk of death (log rank p&lt;0.01 (both) RR=5.3 CI 95% 1.9–14.8 p&lt;0.01; RR=7.8 CI 95% 2.4–25.1 p&lt;0.01 respectively). At multivariate analysis including age, sex and admission LVEF, CEA and CA 19.9 levels higher than median were an independent predictor of MACE at long term (p&lt;0.01 RR 3.5 CI 1.6–7.3).

Conclusion
CEA and CA 19.9 serum levels are associated with higher risk of in-hospital MACE and death at long-term.

Funding Acknowledgement
Type of funding source: None
Aortic coarctation in pregnancy: outcomes and predictors for cardiovascular and hypertensive complications. Data from the ESC Registry of Pregnancy and Cardiac disease (ROPAC)
Authors: Ramlakhan K.P , Tobler D , Greutmann M , Schwerzmann M , Baris L , Yetman A.J , Nihoyannopoulos P , Manga P , Boersma H , Johnson M.R , Hall R , Roos-Hesselink J.W 
Published: November 2020

Abstract

Background
Pregnancy in women with repaired aortic coarctation (CoA) has a moderately increased risk (mWHO II-III) of an adverse cardiovascular, obstetric or fetal event, but prospective data to validate this estimated risk is scarce.

Purpose
We examined maternal and fetal outcomes in pregnant women with unrepaired and repaired CoA to identify predictors of adverse outcomes.

Methods
Pregnancies in women with CoA were selected from the worldwide prospective Registry of Pregnancy and Cardiac Disease (ROPAC, n=5739). The frequency and predictors of major adverse cardiac events (MACE, defined as maternal cardiac death, heart failure, atrial fibrillation/flutter, ventricular tachyarrhythmia, endocarditis, thromboembolic events, aortic dissection and acute coronary syndrome), and hypertensive complications (defined as pregnancy-induced hypertension, (pre)eclampsia or HELLP syndrome) were analyzed.

Results
Of 303 pregnancies in women with CoA (median age 30 years, median pregnancy duration 39 weeks), 10% were in women with unrepaired CoA and 27% in women with pre-existing hypertension. There were no maternal deaths. There were 4 neonatal deaths of which 3 occurred after a spontaneous extreme preterm birth. MACE occurred in 4.3% of pregnancies, predominantly involving heart failure (3.3%). MACE rate was similar in unrepaired vs repaired CoA (3.4% vs 4.4%, p=0.814). Predictors of MACE included pre-pregnancy clinical signs of heart failure (OR 31.8, 95% CI 6.8–147.7), LVEF &lt;40% (OR 10.4, 95% CI 1.8–59.5), NYHA class &gt;1 (OR 11.4, 95% CI 3.6–36.3), cardiac medication use (OR 4.9, 95% CI 1.3–18.3) and living in an emerging country (OR 4.88, 95% CI 1.58–15.07). Hypertensive complications occurred in 6.3%, more often in the subgroup with pre-existing hypertension (11% vs 5%, p=0.040). Pre-existing hypertension was the only predictor (OR 2.6, 95% CI 1.01–6.6). Caesarean section was performed in 50% of the total cohort.

Conclusions
Pregnancies in women with CoA are safe, well tolerated and MACE and hypertensive complication rates are low. These findings support mWHO risk score reevaluation to mWHO II for women with CoA without cardiac impairment.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): ESC EURObservational Research Programme (EORP)
RNA interference targeting apolipoprotein C-III with ARO-APOC3 in healthy volunteers mimics lipid and lipoprotein findings seen in subjects with inherited apolipoprotein C-III deficiency
Authors: Schwabe C , Scott R , Sullivan D , Baker J , Clifton P , Hamilton J , Given B , San Martin J , Melquist S , Watts G.F , Goldberg I , Knowles J.W , Hegele R , Ballantyne C 
Published: November 2020

Abstract

Background
Individuals with triglycerides (TGs) ≥1,000 mg/dL (11.1 mmol/L) are at increased risk of acute pancreatitis. Genetic studies indicate that individuals with apolipoprotein C-3 (APOC3) loss-of-function mutations have low TGs, reduced cardiovascular risk and no observed adverse phenotype. RNA interference (RNAi) with ARO-APOC3 has shown deep and durable knockdown (KD) of APOC3 after single doses in healthy volunteers (HVs, presented at AHA 2019) with good tolerability. We report here initial results using multiple doses of ARO-APOC3 to silence APOC3 expression in HVs.

Methods
ARO-APOC3 was administered subcutaneously to HVs on days 1 and 29 at doses of 10, 25 or 50 mg (n=4 per group). Measured parameters included plasma concentrations of APOC3, LDL-C, TGs, VLDL-C and HDL-C.

Results
All HVs have received both doses and follow-up for most parameters is available through week (wk) 14 (10 wks after second dose) for the 10 and 25 mg doses and through wk 10 for 50 mg. Mean nadir for APOC3 levels occurred at wk 3 for 10 mg (−73%) and remained similar at wk 10 (−66%), at wk 6 for 25 mg (−90%) with no change at wk 10 and at wk 2 for 50 mg (−94%) unchanged at wk 8. TGs fell faster in the 50 mg group (wk 1: 10 mg −41%; 25 mg −47%; 50 mg −72%). By wk 6 the 25 and 50 mg results were similar (−68% and −74%, respectively) and remained similar through wk 14. 10 mg was less active with a nadir of −56% and mean reductions between 42% and 56% post-nadir. VLDL-C values mirrored TGs. LDL-C reductions were more modest and did not manifest a dose response. Mean nadirs (−23–26%) occurred 4–6 wks after the first dose, again with minimal change through 10–14 wks of follow-up. Consistent with genetic studies, HDL-C increased to a maximum at approximately wk 8 (10 mg +42%, 25 mg +48%, 50 mg +84%). ARO-APOC3 was well tolerated without serious or severe adverse events or dropouts related to drug. The most common adverse events were mild injection site AEs and headache.

Conclusions
Genetic deficiency of APOC3 is associated with substantial reductions in TGs, VLDL-C and increases in HDL-C without an adverse phenotype. Using RNAi to selectively suppress APOC3 production mimics these lipid and lipoprotein effects, with a duration of at least 10 weeks following a second dose and with good tolerability over 16 wks using doses ranging from 10 to 50 mg. Investigation of optimal dosing regimen is ongoing, especially with respect to dosing interval. This therapeutic approach has potential for treating patients with chylomicronemia at risk of pancreatitis.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Arrowhead Pharmaceuticals
Fenofibrate or omega-3 fatty acid use is associated with lower long term outcomes from propensity matched analysis of 141972 patients with diabetes in Korean national health insurance cohort
Authors: Jo S.H , Kim H.S , Han S.J , Kim S.A 
Published: November 2020

Abstract

Background
We investigated the clinical effectiveness of fenofibrate or omega 3-fatty acid in patients with diabetes for long term.

Methods
Using Korean National Health Insurance data base, 141972 eligible patients with diabetes were selected. We divided the patients into 2 groups with propensity matching 1:2 ratio, fenofibrate/omega 3 fatty acid users (Fen-O, n=42353) or no users (n=14880). We followed up for 6-years for primary endpoint of death, myocardial infarction (MI), stroke and individual outcomes including cardiac death.

Results
Primary endpoint was significantly lower in Fen-O group as compared to no users, 2.35% vs. 1.58% (HR 0.673, CI: 0.633–0.715, P&lt;0.001) in crude and 2.35% vs. 1.58% (HR 0.641, CI: 0.565–0.728) after adjusting age, sex, medical history analysis, body mass index, LDL-C and HDL-C). All cause death (0.76% vs. 1.24% [HR 0.664, CI: 0.625–0.706], p&lt;0.0001), cardiac death (0.11% vs. 1.19% [HR 0.610, CI: 0.486–0.765, p=0.0001) and stroke (0.57% vs. 0.79%, [HR 0.723, CI: 0.594–0.881, P=0.0013) were significantly lower in Fen-O group. In the survival analysis, Fen-O group showed significantly lower primary outcome rate which is proportional with the days of intaking fenofibrate or omega 3 fatty acid (log rank &lt;0.001),

Conclusions
Use of fenofibrate or omega 3 fatty-acid was associated with lower rate of composite of death, MI, stroke in diabetes patient for 6 year follow-up with large population.

Funding Acknowledgement
Type of funding source: None
Silencing of lipocalin-2 and its receptor improved cardiomyocytes viability via decreasing iron uptake, mitochondrial fission, mitophagy and apoptosis under iron overload condition
Authors: Kumfu S , Chattipakorn S.C , Chattipakorn N 
Published: November 2020

Abstract

Background
Iron overload cardiomyopathy is a common cause of death in iron overload patients. L-type calcium channels (LTCC) and T-type calcium channels (TTCC) have been shown to play important roles for iron uptake into the heart under iron overload condition. Recently, cardiomyocytes which exposed to lipocalin-2 (LCN-2) have been shown to increase apoptosis due to excessive intracellular iron accumulation. However, the mechanistic roles of LCN-2 and LCN-2 receptor (LCN-2R) as iron transporters in cardiomyocytes under iron overload condition have never been investigated.

Purpose
We hypothesized that the LCN-2 and LCN-2R are alternate iron uptake pathways into cardiomyocytes under iron overload condition.

Methods
H9c2 cardiomyocytes were treated with either LCN-2 siRNA or LCN-2R siRNA for 72 hr or LTCC blocker (verapamil), TTCC blocker (TTA-P2), or iron chelator deferiprone (DFP) for 1 hr. After treatment, cells were exposed to ferric ammonium citrate (FAC, Fe3+) or FAC + 1mM ascorbic acid (Fe2+) at 200 μM for 48 hr. Intracellular iron level, cell viability, mitochondrial dynamics, mitophagy and apoptosis were determined.

Results
Both Fe2+ and Fe3+ treated groups showed significantly increased intracellular iron uptake, decreased cell viability, increased mitochondrial fission, mitophagy and apoptotic protein expression in cardiomyocytes. Under Fe2+ overload condition, treatments with LTCC blocker, TTCC blocker, and DFP could significantly decrease intracellular iron accumulation and increase cell viability via decreasing mitochondrial fission, mitophagy and cleaved caspase-3 (Figure), whereas both LCN-2 and LCN-2R siRNA treatment had no beneficial effects on these parameters. Under Fe3+ overload condition, treatment with LCN-2 siRNA, LCN-2R siRNA, and DFP showed beneficial effects on those parameters, whereas neither LTCC nor TTCC blocker provided these benefits (Figure 1).

Conclusion
Silencing of LCN-2 and LCN-2R increased cardiomyocyte viability via decreasing iron uptake, mitochondrial fission, mitophagy and apoptosis under Fe3+ iron overload condition. Meanwhile, treatment with calcium channel blockers improved cardiomyocytes viability via decreasing iron uptake, mitochondrial fission, mitophagy and apoptosis under Fe2+ iron overload condition. All of these findings suggested that LTCC and TTCC played important roles for Fe2+ uptake, whereas LCN-2 and LCN-2R were essential for Fe3+ uptake into the cardiomyocytes under iron overload conditions.
Figure 1. Cell viability and apoptosis

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Thailand Research Fund and NSTDA Research Chair Grant (NC)
Relationship between burnout and nursing practice environment in pediatric cardiology: a cross-sectional study
Authors: Bagnasco A , Zanini M , Dasso N , Rossi S , Catania G , Sasso L 
Published: November 2020

Abstract

Introduction
The relationship between burnout and patient safety is widely demonstrated in the literature. Recent studies have shown that in pediatrics the burnout rates are even higher, thus increasing young patients' exposure to risks. Pediatric cardiology is often characterized by acute onset in the pre-natal period and requires long periods of hospitalization. Strategies to reduce burnout and its impact on patient safety is a priority.

Purpose
To test the relationship between nursing work environment and emotional exhaustion in nurses in pediatric cardiology.

Methods
Data were drawn from the database of a larger study, RN4CAST@IT-Ped, a cross-sectional study in which 13 Italian hospitals were involved.
Convenience sampling was adopted, and inclusion criteria were nurses providing direct routine care in wards. For this study, only data relating to nurses working in Pediatric Cardiology were extracted.
The data were collected through a web survey from September 2017 to January 2018. The questionnaire investigated several aspects relating to care and nursing staff including workload, skill mix, work environment measured with PES-NWI, and emotional exhaustion with the Maslach Burnout Inventory. Descriptive statistical analyses were conducted to describe the sample and variables taken into consideration; a binomial logistic regression model was built to test the relationships between the dependent variable “high Emotional Exhaustion” and the independent variables “PES-NWI composite score”, adjusted for “workload” and “skill mix”.

Results
The responses from eighty-five pediatric nurses from 7 units (mixed cardiology-cardiac surgery, cardiology, arrhythmology, cardiac surgery and a cardiology intensive care unit), in 5 hospitals, were analyzed.
These findings show that with the same skill mix and workload, the improvement of the workplace environment conditions decreased by 81% (OR 0.192; 95% CI 0.062–0.591) the risk that nurses working in pediatric cardiology would develop a high level of Emotional Exhaustion.

Conclusions
Demonstrating the association between emotional exhaustion and work environment in pediatric cardiology is only a first step towards improvement. Workplace environment includes relational, logistic, and organizational aspects that require further investigation to ensure that nursing in pediatric cardiology is even safer and of better quality in all its key aspects: urgency, intensity, chronicity and complexity.

Funding Acknowledgement
Type of funding source: None