bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vaccine-preventable diseases in hospitalized patients with heart failure: a nationwide cohort analysis
Authors: Patil S.P , Gonuguntla K , Rojulpote C , Joshi S , Borja A.J , Kumar M 
Published: November 2020

Abstract

Introduction
Infection related hospitalizations are common among patients with heart failure (HF), including those that could be prevented with appropriate vaccinations.

Objective
We aimed to determine the risk of vaccine preventable diseases (VPDs) in patients with HF.

Methods
We performed a population based retrospective cohort study using the United States- National Inpatient Sample (NIS) Database from 2010 to 2014. We identified patients who were admitted to the hospital with vaccine preventable diseases, namely influenza, varicella zoster infection (VZV), pneumococcal infection, meningococcal infection, diphtheria, pertussis, tetanus, hepatitis A (Hep A) and hepatitis B (Hep B) using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. In this cohort, we then identified patients with HF. Descriptive statistics were used to estimate the frequencies of various VPDs in patients with heart failure. A multivariate regression model adjusting for age, gender, race, immunosuppression (Diabetes, HIV, Organ transplantation, Malignancy) was employed to determine the risk of VPDs in patients with HF.

Results
Among a total of 11, 64,528 patients admitted with VPDs, HF was present in 1, 01,915 (8.8%).The most common VPD in patients with HF was VZV (30.7%), followed by influenza (28.2%), pneumococcal infection (20.9%) and Hep B (18.5%). Other VPDs were less common: Hep A (1.8%), diphtheria (0.4%), pertussis (0.2%), tetanus (10 patients) and meningococcal infection (0.1%). On multivariate analysis, patients with HF had increased risk of hospitalization due to influenza (aOR=1.20, 95% CI: 1.18–1.21; p&lt;0.001) and pneumococcal infection (aOR=1.31, 95% CI: 1.29–1.33; p&lt;0.001), but were at a lower risk of hospitalization due to VZV (aOR=0.81, 95% CI: 0.8–0.83; p&lt;0.001), Hep B (aOR=0.78, 95% CI: 0.77- 0.8; p&lt;0.001), Hep A (aOR=0.71, 95% CI: 0.67–0.74; p&lt;0.001), Meningococcal infection (aOR=0.64, 95% CI: 0.52–0.78; p&lt;0.001), diphtheria (aOR=0.79, 95% CI: 0.71–0.88; p&lt;0.001) and tetanus (aOR=0.35, 95% CI: 0.19–0.65; p=0.001). No statistically significant association of HF was observed with pertussis (p=0.167).

Conclusion
In our study, patients with HF had a higher risk of hospital admissions secondary to influenza and pneumococcal infections and a lower risk of VZV, Hep B, Hep A, meningococcal infection, diphtheria, and tetanus related admissions when compared with non-HF patients.

Funding Acknowledgement
Type of funding source: None
Anthracycline-induced cardiotoxicity: molecular and genetic predictors for risk assessment
Authors: Grakova E , Shilov S.N , Berezikova E.N , Popova A.A , Neupokoeva M.N , Kopeva K.V , Van-Tin-Gao A.A , Ratushniak E.T , Teplyakov A.T 
Published: November 2020

Abstract

Objective
The objective of this study was to evaluate the role of molecular and genetic biomarkers in the development of anthracycline-induced cardiotoxicity in women with breast cancer at the 12 months after polychemotherapy.

Methods
A total of 176 women, median age of 45,0 [42,0; 50,0] years with breast cancer without cardiovascular diseases who received anthracycline antibiotics as part of polychemotherapeutic treatment were enrolled in the study. Two-dimensional transthoracic echocardiography and 6-minute walk test were performed at baseline and at the 12 months after polychemotherapy. Serum levels of NT-proBNP, sFas-L were measured using an enzyme immunoassay after polychemotherapeutic treatment. Evaluation of gene polymorphisms of p53 protein (polymorphic marker-Arg72Pro exon 4, rs1042522) and nitric oxide synthase (NOS3, Glu298Asp, rs1799983) were carried out by polymerase chain reaction at baseline.

Results
After the 12 months of polychemotherapy all patients had breast cancer remission and were divided into 2 groups: group 1 (n=52) comprised patients with anthracycline-induced cardiotoxicity, group 2 (n=124) comprised those without it. After polychemotherapeutic treatment the median value of NT-proBNP in group 1 was higher (p&lt;0,00001) by 52,4% than in group 2 (113 [101,8; 126,15] pg/mL and 53,8 [43,4; 63,0] pg/mL, respectively). The median value of sFas-L in group 1 was higher (p&lt;0,00001) by 44,3% than in group 2 (125,3 [111,85; 133,95] pg/mL and 69,8 [59,8; 77,6] pg/mL, respectively). Based on ROC-analysis, sFas-L concentration of 95.8 pg/mL (sensitivity of 92.2%, specificity of 92.1%, and AUC=0,951; p=0,0001) and NT-proBNP concentration of 71.5 pg/mL (sensitivity of 99.9%, specificity of 91.9%, and AUC=0,951; p=0,0001) were identified as a cut-off values predicting the development of anthracycline-induced cardiotoxicity. The development of anthracycline-induced cardiotoxicity in women with breast cancer at the 12 months after polychemotherapy significantly was related to the presence of T/T genotype of NOS3 gene (OR = 3,059; p=0,018) and with Arg/Arg genotype of p53 protein gene (OR = 2,972; p=0,001). While, the presence of Pro/Pro the Pro53 gene genotype of p53 protein gene was related to the absence of anthracycline-induced cardiotoxicity.

Conclusion
Our data suggest that evaluation of polymorphisms gene of p53 (rs1042522) and NOS3 (rs1799983) can be recommended before polychemotherapy in women with breast cancer for the risk assessment of anthracycline-induced cardiotoxicity. The serum levels of NT-proBNP and sFas-L after polychemotherapy may be considered as non-invasive biomarkers for prediction of the development of anthracycline-induced cardiotoxicity in women with breast cancer during the 12 months after polychemotherapy.

Funding Acknowledgement
Type of funding source: None
Why do frail patients with chronic heart failure die and become hospitalised?
Authors: Sze S , Pellicori P , Zhang J , Weston J , Clark A.L 
Published: November 2020

Abstract

Background
Frailty is common in patients with heart failure (HF) and is associated with increased morbidity and mortality. A better understanding of the causes of hospitalisations and death in frail patients might help to tailor interventional strategies for these at-risk patients.

Purpose
We studied the cause of death and hospitalisations in ambulatory patients with HF and frailty.

Methods
We assessed frailty using the clinical frailty scale (CFS) in consecutive HF patients attending a routine follow-up visit. Those with CFS ≥5 were classified as frail. Mortality and hospitalisations were ascertained from medical records (updated systematically using an NHS electronic database), discharge letters, autopsy reports and death certificates. We studied the primary cause of death and hospitalisations within one year of enrolment.

Results
467 patients (67% male, median (IQR) age 76 (69–82) years, median (IQR) NT-proBNP 1156 (469–2463) ng/L) were enrolled. 206 (44%) patients were frail. Frail patients were more likely to not receive or receive suboptimal doses of ACEi/ARB and Beta-blockers; while non-frail patients were more likely to be treated with optimal doses.
At 1-year follow up, there were 56 deaths and 322 hospitalisations, of which 46 (82%) and 215 (67%) occurred in frail patients. Frailty was associated with an increased risk of all-cause mortality (HR (95% CI): 4.27 (2.60–7.01)) and combined mortality/ hospitalisation (HR (95% CI): 2.85 (2.14–3.80)), all p&lt;0.001. 57% (n=26) of frail patients died of cardiovascular causes (of which 58% were due to HF progression); although deaths due to non-cardiovascular causes (43%, n=20), especially severe infections, were also common (26%, n=12). (Figure 1)
The proportion of frail patients who had non-elective hospital admissions within 1 year was more than double that of non-frail patients (46% (n=96) vs 21% (n=54); p&lt;0.001). Compared to non-frail patients, frail patients had more recurrent (≥2) hospitalisations (28% (n=59) vs 9% (n=24); p&lt;0.001) but median (IQR) average length of hospital stay was not significantly different (frail: 6 (4–11) vs non-frail: 6 (2–12) days, p=0.50). A large proportion of hospitalisations (64%, n=137) in frail patients were due to non-cardiovascular causes (of which 34%, 30% and 20% were due to infections, falls and comorbidities respectively). Of cardiovascular hospitalisations (36%, n=78), the majority were due to decompensated HF (67%, n=46). (Figure 1)

Conclusion
Frailty is common in patients with HF and is associated with an increased risk of mortality and recurrent hospitalisations. A significant proportion suffered non-cardiovascular deaths and hospitalisations. This implies that interventions targeted at HF alone can only have limited impact on outcomes in frail patients.
Figure 1

Funding Acknowledgement
Type of funding source: None
Diastolic and systolic function of diabetic cardiomyopathy are affected by diffuse myocardial fibrosis: a cardiac MRI study
Authors: Bojer A.S , Soerensen M.H , Gaede P , Madsen P.L 
Published: November 2020

Abstract

Background
Increased myocardial extracellular volume (ECV) likely is suggested to be of importance for cardiac function in type 2 diabetes (T2DM).

Purpose
We analysed the effect of increasing ECV on cardiac myocardial structure and function and association to typical complications related to diabetes

Methods
296 patients (pt.) with T2DM and 25 controls were recruited. Cardiac magnetic resonance scan with adenosine stress and gadolinium was performed. Left ventricle (LV) diastolic function was evaluated by echo Doppler.

Results
246 pt. scan and all control scans were available for analysis. ECV was significantly different between pts. and controls (29.5±3.3 vs 26.1±1.5, P&lt;0.001). Pts. were grouped in ECV percentiles: ≤25, 25–75, and ≥75. Pts. with ECV in the highest percentile had lowered LV ejection fraction (LVEF) and increased LV end-diastolic (EDV) and end-systolic (ESV) volumes, and left atrial (LA) maximal volume. No difference was found on LV mass. With increasing ECV a lowered LV myocardial perfusion index (MPRI) and an increased prevalence of albuminuria, retinopathy, and autonomic neuropathy was found. Of interest, with increasing ECV lateral as well as septal e' were lowered and the E/e' increased.

Conclusions
In combination with lowered myocardial perfusion but independently of myocardial hypertrophy, myocardial interstitial diffuse fibrosis is related to the diastolic dysfunction of diabetic cardiomyopathy.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): NSR hospital, Denmark and the Danish Heart Foundation
The incidence, clinical significance of depression and its clinical course after a cardac device implantation in patients with severe heart failure
Authors: Podolecki T , Pudlo R , Mazurek M , Jedrzejczyk-Patej E , Koziel M , Sokal A , Kowalski O , Lenarczyk R , Kalarus Z 
Published: November 2020

Abstract

Aim
To assess the incidence, clinical significance of depression and the impact of a cardioverter-defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) implantation on psychiatric status in patients with heart failure (HF).

Methods
The prospective, single-center study encompassed 575 consecutive HF patients implanted with a CRT-D or ICD. Finally, the study population consisted of 494 subjects (186 ICD and 308 CRT-D patients), as 81 patients taking antidepressants were excluded from the analysis. All patients underwent psychiatric examination at the time of implantation, and the assessment of psychiatric status was repeated after 3, 6, 12 and 24 months. The study population was divided into 4 groups: Group 1 encompassed 101 (20.4%) patients with persistent depression, Group 2 constituted of 95 (19.2%) patients with depression that developed after ICD/CRT-D implantation, whereas 43 (8.7%) patients with remission of depression comprised Group 3, and Group 4 encompassed 255 (51.6%) patients with never diagnosed depression. Data on long-term follow-up (median 34.1 months) were screened to identify patients who developed a composite endpoint defined as death or hospitalization for decompensated HF.

Results
The cumulative incidence of depression at the baseline assessment was 39.1%. Depression developed in 95 (27.1%) patients, whereas remission of depression was observed in 43 (29.9%) subjects after ICD/CRT-D implantation. ICD intervention (HR 3.3) and increase in NYHA class by at least one class (HR 2.6) were the independent risk factors for depression development, whereas mitral regurgitation reduction (HR 1.9), as well as improvement in NYHA class by at least one class (HR 2.4) were the independent predictors for depression remission. Patients with persistent depression (Group 1) and those with newly developed depression (Group 2) were at significantly higher risk of a composite endpoint compared to patients in Group 3 and Group 4 (Table 1).

Conclusions
Depression is a common comorbidity associated with HF, as it affects 4 of 10 HF patients. ICD intervention and HF worsening are the strongest predictors for depression development after ICD/CRT-D implantation. Depression is a strong, independent risk factor of poor outcomes in HF population.

Funding Acknowledgement
Type of funding source: None
Pattern and predictors of one-year mortality in heart failure: China PEACE Prospective Heart Failure Study
Authors: Li J , Zhang L , Liu J , Bai X , Zhang H , Huo X 
Published: November 2020

Abstract

Background
Heart failure (HF) is a global public health problem, which causes high mortality.

Purpose
To characterize the pattern of 1-year mortality, including the rate and timing of death, and to identify clinical and non-clinical factors predicting 1-year all-cause mortality after hospitalization for HF.

Methods
We prospectively enrolled patients who were hospitalized primarily for HF and discharged alive from 52 hospitals across 20 provinces in China between August 2016 and May 2018, and followed them up by face-to-face interview or telephone. Patients' fatal status were ascertained according to investigators' report and national death registration. Cognitive function was measured by Mini-Cog score and health status was measured by Kansas City Cardiomyopathy Questionnaire (KCCQ). We fitted a Cox proportional hazards model accounting for hospital as random effects to identify patient characteristics associated with 1-year all-cause mortality.

Results
Among 4899 patients, 4882 (97.7%) completed 1-year follow-up. The median (IQR) age was 67 (57, 75) years and 37.5% were women. The main etiology of HF was ischemic heart disease (53.1%), 66.0% of patients had history of HF before the index hospitalization. Among 813 deaths within one year after discharge, 13.4% and 58.4% occurred within one months and six months, respectively. Systolic blood pressure &lt;100mmHg at admission (hazard ratio [HR] 2.33, 95% CI 1.76–3.08), NYHA class IV (HR 1.37, 95% CI 1.1–1.7), anemia (HR 1.3, 95% CI 1.1–1.54), hs-cTNT≥18 ng/L (HR 1.84, 95% CI 1.53–2.22), hyponatremia (HR 1.66, 95% CI 1.38–1.98), LVEF&lt;40% (HR 1.25, 95% CI 1.02–1.53), QRS interval≥120mms (HR 1.19, 95% CI 1.02–1.4), Cognitive impairment (HR 1.25, 95% CI 1.07–1.46) and low KCCQ score (HR 1.24 per 25 score decrease, 95% CI 1.11–1.39) were associated with higher risks of 1-year all-cause mortality. In contrast, female (HR 0.83, 0.7–0.99), sleep apnea syndrome (HR 0.55, 95% CI 0.35–0.88) were associated with lower risks of 1-year all-cause mortality.

Conclusion
In China, one in six patients hospitalized for HF die within 1-year, with the majority occurring during the first 6 months after hospital discharge. Both clinical and non-clinical factors predict 1-year mortality.

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
Direct comparison of BNP and NT-proBNP for mortality prediction in patients with acute dyspnea
Authors: Wussler D , Belkin M , Strebel I , Kozhuharov N , Sabti N , Nowak A , Michou E , Flores D , Gualandro D , Breidthardt T , Mueller C 
Published: November 2020

Abstract

Background
It is unclear whether BNP or NT-proBNP, their admission or discharge measurement or percentage change during hospitalization are preferable for mortality prediction in patients with acute dyspnea.

Purpose
To directly compare BNP and NT-proBNP regarding their potential in mortality prediction in patients with acute dyspnea and in patients with dyspnea due to AHF.

Methods
In a prospective multicenter diagnostic study the presence of AHF was centrally adjudicated by two independent cardiologists among patients presenting with acute dyspnea. The levels of BNP and NT-proBNP were measured at presentation and discharge. Patients were stratified according to their natriuretic peptide response (responders vs. non-responders: natriuretic peptide decrease ≥25% vs. &lt;25% before discharge). Prognostic accuracy for 720-day mortality was quantified using the area under the receiver-operating-characteristic curve (AUC). Cox proportional hazard models were constructed to identify significant predictors for 720-day mortality.

Results
Among 1156 patients presenting with acute dyspnea, 353 (30.5%) died within 720 days of follow-up. Prognostic accuracy for death at 720 days was significantly higher for discharge compared to admission measurements for BNP (AUC 0.750 vs. 0.711, p&lt;0.001) and NT-proBNP (AUC 0.769 vs. 0.720, p&lt;0.001). When directly comparing discharge measurements, NT-proBNP levels exhibited a significantly higher accuracy (p=0.013). 632 (54.6%) and 600 (51.9%) patients were BNP and NT-proBNP non-responders, respectively. Among BNP and NT-proBNP non-responders 202 (32%) and 207 (34.5%) patients died within 720 days of follow-up. After adjusting for common covariates NTproBNP response was the strongest predictor for 720-day mortality in a Cox regression model (Hazard ratio for NT-proBNP non-responders: 2.096 (95% CI 1.550–2.835), p&lt;0.001). Results were confirmed in a sensitivity analysis of 687 (59.4%) patients with adjudicated AHF.

Conclusion
Percentage change of NT-proBNP during hospitalization seems to be the strongest predictor for long-term mortality in patients with acute dyspnea in general and in those with dyspnea due to AHF in particular.
ROC curve for direct comparison

Funding Acknowledgement
Type of funding source: None
Urinary chlorine: a potential biomarker of diuretic resistant patients
Authors: Zegri Reiriz I , Garcia-Coscuella D , Moreno T , Ortega R , Ruiz A , Mesado N , Aran F , Brossa V , Camprecios M , Lopez L , Roig E , Mirabet S 
Published: November 2020

Abstract

Background
Natriuresis is gaining growing interest in identifying diuretic resistance (DR) patients. However, it has not been proved useful beyond the first day with intravenous (iv) furosemide. Moreover, data regarding urinary chlorine (uCl) or urinary potassium (uK) are scarce. We sought to assess the urine electrolyte pattern in acute heart failure (AHF) outpatients to identify those who will present DR.

Methods
Single-center prospective registry of outpatients with AHF who need iv furosemide. In visit 1 (V1), baseline spot urine sample was collected. Furosemide iv bolus plus intensification of oral diuretics were performed. In control visit (V2), baseline spot urine sample was collected and congestion data were evaluated. Urine electrolytes were assessed in relation to DR (defined as need of iv furosemide in V2 due to persistent congestion).

Results
From June to December 2019, 76 patients were included: median age of 75.5 years (68.2–82), glomerular filtration 40 ml/min/1.73m2 (29.2–59.2) and NT-proBNP 3340 ng/L (1296–7044).
In V1, DR patients showed higher levels of uK and lower uNa/uK than NDR (p=0.014 and p=0.007, respectively). In V2, after a median of 6 (6–15) days of intensified diuretic treatment, uNa and uCl dropped with adequate decongestion but not in DR patients (p=0.020 and p=0.001, respectively). Thus, DR patients showed in V2 higher uCl and similar uNa than NDR (table).

Conclusions
After several days of intensified diuretic treatment, uCl and uNa dropped during proper decongestion but not in DR patients, showing higher levels of uCl than NDR. Mantained levels of uCl could help to identify patients with persistent congestion.

Funding Acknowledgement
Type of funding source: None
N-terminal pro-B-type natriuretic peptide in the diagnosis of acute heart failure
Authors: Lee K.K , Doudesis D , Anwar M , Astengo F , Japp A , Tsanas A , Shah A.S.V , Januzzi J.L , Mills N.L 
Published: November 2020

Abstract

Background
N-terminal pro-B-type natriuretic peptide (NT-proBNP) testing can aid in the evaluation of patients with suspected acute heart failure. Current approaches are based on thresholds selected to give good negative and positive predictive value, however the optimal means to utilise NT-proBNP is uncertain.

Methods
Embase, Medline and Cochrane central register of controlled trials were searched for studies evaluating NT-proBNP in patients with suspected acute heart failure. Individual patient-level data was requested and diagnostic performance for the guideline-recommended rule-out (300 pg/mL) and age-specific rule-in (450, 900 and 1,800 pg/mL) thresholds were evaluated with random-effects meta-analysis. A generalised linear mixed model was developed and validated as a decision-support tool that combines NT-proBNP with clinical characteristics to report the probability of acute heart failure (0–100) for an individual patient.

Results
Fourteen studies from 13 countries provided individual patient-level data in 10,365 patients, of which, 43.9% (4,549/10,365) had an adjudicated diagnosis of acute heart failure. At the rule-out threshold, the negative predictive value (NPV) was 94.6% (91.9%-96.4%), with significant heterogeneity across patient subgroups (see Figure). At the rule-in thresholds, the positive predictive values (PPV) for those &lt;50 years, 50–75 years, and &gt;75 years were 61.0% (55.3%-66.4%), 72.7% (62.1%-81.3%) and 80.5% (71.1%-87.4%), respectively. In patients without prior heart failure, our model had good discrimination and calibration (area under the curve of 0.931 [0.925–0.938], Brier score of 0.094). A score of &lt;5.6 and ≥45.2 identified 42.3% of patients as low-probability of acute heart failure (NPV 98.5%, 97.6%-99.1%) and 30.5% as high-probability (PPV 75.1%, 67.7%-81.3%) with consistent performance across subgroups.

Conclusions
The diagnostic performance of NT-proBNP thresholds to rule-out and rule-in acute heart failure varies across patient subgroups. A model that uses NT-proBNP as a continuous measure provides a more consistent and individualised approach.
NPV of NT-proBNP threshold of 300 pg/mL

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation