bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of adrenaline-packed dressing for bleeding control in patients undergoing cardiovascular implantable electronic device implantation; A Single-Center study
Authors: Anusonadisai K , Suwanagool A 
Published: November 2020

Abstract

Background
Each year, 1.65 million people around the world are implanted with Cardiac Implantable Electronic Devices [CIEDs], which our center, performed about 300–350 cases per year. These implantation process needs expertise and specializes in preventing the complication. Some complications, such as device-related bleeding complications (DRBCs) and pocket hematoma, especially in those patients receiving oral antithrombotic drugs before the surgery, should be preventable. Based on our observation of cases in the operation room, the wounds which were easily bleed can effectively create hemostasis by using adrenaline-packed dressing. The purpose of this study is to explore if the adrenaline pack dressing could reduce bleeding complications and reduce pocket hematoma in patients undergoing CIED implantation.

Purpose
To evaluate if adrenaline-packed dressing during CIED implantation can demonstrate a reduction in bleeding complication.

Methods
This is a single-center double-blind, randomized control study that included most of the patients undergoing CIED implantation in our center from June 2019 to Jan 2020. The patients will be randomized to adrenaline-packed dressing or matched control group. The protocol requires each patient to have a 2-weeks evaluation at the device clinic by two device-clinic staff. If DRBCs are detected, we used a caliper to measure the size in the largest dimension. Our primary outcome is the incidence of DRBCs at 2-weeks.

Results
There were 165 patients enrolled from June 2019 to Jan 2020. Mean age was 73 (female 52%), 24% on antiplatelet, 36% on anticoagulant. The pocket hematoma and ecchymosis at the 2-week was 15.8% and 15.2%, respectively. The DRBCs at 2-weeks was not significantly different between groups (22.6% vs. 33.3%; p=0.125). However, the next morning hematoma was significantly decreased in the adrenaline-packed dressing group (13.1% vs. 28.4%; p=0.015). The trend of subgroup analysis in the adrenaline pack dressing group was showing a reduction of DRBCs in patients who on anticoagulation therapy.

Conclusion
The adrenaline pack dressing appears to reduce early pocket hematoma significantly, but at two weeks, most of them were resolved and make no significant difference between groups.

Funding Acknowledgement
Type of funding source: None
Repeated lead extraction – the new challenge. Experience from 3207 TLE procedures
Authors: Kutarski A , Tulecki L , Czajkowski M , Tomkow K , Nowosielecka D , Stefanczyk P , Polewczyk A , Jachec W 
Published: November 2020

Abstract

Background
Transvenous lead extraction (TLE) is optimal option of management of lead-related problems. Usually the procedure has favourable long-term effect. Most of patients get the new or restored pacing system and risk of following lead-related problems may occur again. The knowledge about re-extraction procedures is limited.

Methods
In high volume centre during the last 15 years 3207 TLE procedures were performed and 1–6 leads (aver 1,65, with mean oldest implant duration 96,6 mth) were extracted using as first line non-powered mechanical tools. Other tools were used if necessary. We analysed data of first TLE procedures and repeated extractions.

Results
Are presented in the table. Re-extractions include 4,3% of all TLE procedures. Re-infection is less frequent reason for re-extraction (26,8%). Most re-extractions were performed because of dysfunction or damage of lead, which was newly implanted (56) or preserved during previous TLE (20). The last one indicates, that during TLE procedure it should be considered to replace all existing leads, not only these damaged or dysfunctional.

Conclusion
Re-extractions are safe procedures with very good results. Previously performed extraction is not a risk factor for another TLE procedure. Re-extraction should not be avoided in lead management strategy.
Table 1

Funding Acknowledgement
Type of funding source: None
Effect of SGLT-1/2 inhibition on mitochondrial dysfunction in left atrial remodeling during HFpEF
Authors: Bode D , Semmler L , Hegemann N , Primessnig U , Wakula P , Pieske B.M , Messroghli D , Heinzel F.R , Hohendanner F 
Published: November 2020

Abstract

Background
In the DAPA-HF trial, SGLT inhibition reduces cardiovascular mortality in heart failure. However, the mechanism and a potential positive effect in HfpEF remain elusive.

Introduction
LA remodeling is a hallmark feature of HFpEF and commonly associated with LA enlargement and dysfunction. Previous studies of SGLT-2 inhibitor Empagliflozin suggest a utilization of alternative metabolites for energy consumption (i.e. ketone bodies). Additionally, alterations of sodium and calcium ion hemostasis have been reported. We investigated the effect of SGLT inhibition on mitochondrial (dys)function during atrial remodeling in HFpEF.

Methods
Rats (WT: Wistar Kyoto, HFpEF: ZFS-1 Obese (metabolic syndrome)) were obtained at ∼10w and fed Purina 5008 diet. At 17w, animals were randomized to treatment with either vehicle or Sota (30mg/kg/d) for 5w until primary adult cardiomyocytes were isolated for final experiments. Structural information of mitochondria was obtained with Mitotracker Red in either a glucose starved (1h incubation with mannitol) or saturated state. ROS production was assessed with H2-DCF in a starved and saturated condition. Mitochondrial calcium buffer capacity was imaged with Rhod-2 following perforation of the cellular membrane with saponin. Glycolytic dependency of calcium cycling was assessed upon glycolytic inhibition with 2-deoxyglucose during imaging of cytosolic calcium transients with Fura-2.

Results
In a glucose saturated state, LA cardiomyocytes in HFpEF showed increased mitochondrial density, which was ameliorated with Sota. Sota increased mitochondrial calcium buffer capacity in HFpEF, indicating a decrease in mitochondrial resting calcium. Differences in mitochondrial fission could not be detected. However, during glucose starvation cardiomyocytes showed a decrease in mitochondrial fission and ROS production with Sota. A difference in ROS production was not visible when cells were abruptly challenged with high glucose concentrations, but Sota decreased mitochondrial fission, indicating long term protective properties towards ROS. Glycolytic inhibition led to an increase of cytosolic diastolic calcium and calcium transient peak height in HFpEF vs. WT, indicating an increased glucose dependency of cytosolic calcium cycling, which was mitigated with Sota. Additionally, Sota negated an increase in diastolic calcium, when cardiomyocytes where challenged with high concentrations of glucose after starvation.

Conclusion
SGLT1/2 inhibition alters mitochondrial calcium uptake in HFpEF and positively affects mitochondrial structure with subsequent decreases of ROS production and enhanced calcium homeostasis.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Else-Kröner-Fresenius-Stiftung, Deutsches Zentrum für Herz-Kreislaufforschung
Reduced cognitive function is associated with poor outcomes in HFpEF: a post hoc analysis from PARAGON-HF
Authors: Dewan P , Jhund P.S , Anand I.S , Desai A.S , Pieske B , Rizkala A.R , Shah S.J , Shi V.C , Van Veldhuisen D.J , Zannad F , Zile M.R , Solomon S.D , McMurray J.J.V 
Published: November 2020

Abstract

Background
Little is known about the prevalence and consequences of cognitive impairment in patients with heart failure and preserved ejection fraction (HFpEF).

Purpose
To describe the prevalence of cognitive impairment in HFpEF and the association between cognitive function and outcomes in patients with HFpEF.

Methods
In the Prospective Comparison of ARNI With ARB Global Outcomes in Heart Failure With Preserved Ejection Fraction trial (PARAGON-HF), cognitive function was tested in a subgroup of patients at baseline and during follow-up, using the Mini-Mental State Examination [MMSE] which has a maximum score of 30, with a higher score reflecting better cognitive function. Patients were divided into 3 groups according to baseline score: ≤24 representing cognitive impairment, 25–27 reflecting borderline cognitive impairment and ≥28 normal cognition. The primary endpoint used in this analysis was a composite of first heart failure hospitalization (HFH) or cardiovascular death (CVD). We examined the relationship between baseline MMSE score and this outcome, its components and all-cause mortality. We adjusted for other standard prognostic variables, including NT-proBNP (see Table footnote).

Results
Among the 2895 patients (60% of total) in PARAGON-HF with a baseline MMSE measurement, 415 (14.3%) had a score ≤24, 671 (23.2%) a score 25–27 and 1809 (62.5%) a score ≥28. Over a median follow-up of 35 (IQR 30–41) months, the unadjusted and adjusted risks of the primary composite (Table), its components and all-cause death (Figure) were higher in patients with lower baseline MMSE scores.

Conclusions
Even mild cognitive impairment, as measured by the MMSE, is predictive of adverse outcomes in HFpEF

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): PARAGON-HF was funded by Novartis Pharma
The association of digoxin with mortality in ischemic heart failure: a secondary analysis of the STICH trial
Authors: Pandya L , Brown D.L 
Published: November 2020

Abstract

Background
Digoxin, one of the first treatments for symptoms of congestive heart failure (CHF), is currently used in the management of persistent CHF symptoms as well as for ventricular rate control in atrial fibrillation. Current guidelines suggest digoxin as an adjunct to optimal medical therapy for symptomatic improvement in CHF. However, the data regarding the effect of digoxin use on mortality continue to be conflicting.

Purpose
The aim of this retrospective study was to evaluate the association of digoxin therapy with mortality in patients with ischemic heart failure defined by severe left ventricular (LV) dysfunction and coronary artery disease (CAD) in the Surgical Treatment for Ischemic Heart Failure (STICH) trial.

Methods
STICH randomized 1012 patients with CAD and LV ejection fraction&lt;35% to coronary artery bypass graft (CABG) surgery and medical therapy vs. medical therapy alone. Factors predictive of digoxin use were identified with a binomial logistic regression model. Multivariable Cox proportional hazards modelling was performed with digoxin use modelled as a segmented time-dependent covariate. The model was adjusted for baseline clinical characteristics (including age, race, hypertension, hyperlipidemia, diabetes mellitus, peripheral vascular disease, NYHA heart failure class, previous myocardial infarction, atrial fibrillation, creatinine level, smoking status, and STICH treatment group) and stratified based on sex. All covariates were verified to meet the proportional hazards assumption. The primary outcome was all-cause mortality. Secondary outcomes included death and hospitalization due to cardiovascular causes. Relative risks were expressed as adjusted hazard ratios (aHR) with 95% confidence intervals (CI).

Results
Of the 1012 patients, 351 (35% [36% of male patients and 27% of female patients]) reported digoxin use for some duration during the study period. Significant predictors of digoxin use included minority status, NYHA class, previous myocardial infarction, and baseline diagnosis of hypertension, diabetes, or atrial fibrillation. At a mean follow-up of 9.8 years, 566 patients (55.7%) experienced all-cause mortality and 387 patients (38.1%) died due to cardiovascular causes. The adjusted Cox proportional hazards model demonstrated that digoxin use was independently associated with an increased risk of all-cause mortality (aHR 1.22, 95% CI: 1.00–1.49, P=0.049). Digoxin use was also associated with increased risk of cardiovascular death (aHR 1.29, 95% CI: 1.02–1.64, P=0.032). There was no impact of digoxin on hospitalization for cardiovascular causes.

Conclusion
Use of digoxin in patients with ischemic heart failure was associated with an increased risk of both all-cause and cardiovascular death.

Funding Acknowledgement
Type of funding source: None
Usefullness of peak mitral regurgitation velocity to left ventricular outflow tract time velocity integral ratio as a new prognostic marker for one year and long term mortality in failing heart
Authors: Ozcan Cetin E.H , Balci K , Cetin M.S , Unal F , Tekin Tak B , Ekizler F.A , Erdol M.A , Ozcan F , Ozeke O , Cay S , Temizhan A , Topaloglu S , Aras D 
Published: November 2020

Abstract

Background and aim
Systemic vascular resistance (SVR) is useful for risk estimation and therapy guidance in HF. It has been showed that the ratio of peak mitral regurgitation velocity (MRV) to left ventricular outflow tract velocity-time integral (LVOT VTI) correlated positively with SVR. We aimed to assess the association of MRV/LVOT VTI ratio with established prognostic markers and its prognostic role for predicting one year and long term composite end-points in patients with HF and reduced ejection fraction (HFrEF).

Material and methods
We prospectively enrolled a total of 72 patients with HFrEF and 10 control subjects. Patients were followed up patients for median 40.5 months. Primary composite endpoint (CEP) was defined as any of these outcomes including requiring mechanical circulatory support, cardiac transplantation and all-cause mortality.

Results
CEP(+) patients had higher MRV/LVOT VTI ratio than others (0.48±0.15 vs. 0.39±0.18 p=0.012). MRV/LVOT VTI ratio was positively correlated with functional status (β=0.539, p=0&lt;001), serum BNP level (β=0.479, p&lt;0.001),troponin I (β=0.415, p&lt;0.001), and Uric acid level (β=0.235 p=0.018) and negatively correlated with SEATTLE score derived life expectancy (β=−0.248, p=0.032). Adjusted with other parameters, every 0.1 increase in MRV/LVOT VTI ratio increased the one-year CEP risk by 27% and long-term CEP risk by 24.6%. In Kaplan Meier analysis, patients with MRV/LVOTVTI ratio ≥0.39 had more long-term CEP compared to others.

Conclusion
MRV/LVOT VTI ratio seemed to be useful predictor of poor prognosis associated with other established HF prognostic markers.
Figure 1

Funding Acknowledgement
Type of funding source: None
Prognostic implications of late gadolinium enhancement for re-worsening left ventricular ejection fraction in patients with dilated cardiomyopathy: a longitudinal study of left ventricular function
Authors: Nabeta T , Ishii S , Ikeda Y , Maemura K , Oki T , Yazaki M , Fujita T , Naruke T , Inomata T , Ako J 
Published: November 2020

Abstract

Background
Re-worsening left ventricular ejection fraction (LVEF) after initial recovery occurs in some patients with dilated cardiomyopathy (DCM). However, prevalence and predictors of re-worsening LVEF in longitudinal follow-up are unclear. Late gadolinium enhancement of cardiovascular magnetic resonance (LGE-CMR) can evaluate the damage of myocardial tissue.

Purpose
This study sought to evaluate the clinical parameters including LGE-CMR to predict re-worsening LVEF in patients with recent-onset DCM.

Methods
We included patients with recent-onset DCM who had an LVEF &lt;45% and underwent LGE-CMR at diagnosis. We performed yearly echocardiographc follow-up [median 6 [4–8.3] years]. Initial LVEF recovery defined as patients increased in &gt;5% LVEF from baseline and had an LVEF≥45% after medical therapy. Patients were divided into three groups: (1) Improved: defined as those with sustained LVEF ≥45% after initial LVEF recovery; (2) Re-worse: those with decreased &gt;5% and had an LVEF &lt;45% after initial LVEF recovery. and (3) Not-improved: those with no initial LVEF recovery during follow-up. To evaluate the prognostic factors for Re-worsening LVEF after initial LVEF recovery, multivariate logistic regression analysis performed between the Improved group and the Re-worse group. Cardiac events defined as hospitalization due to heart failure and sudden death.

Results
Of 138 patents, 82 patients (59%) were the Improved group, 42 patients (30%) were the Re-worse group, and 14 (10%) were the Not-improved group. Loess curves of long-term LVEF trajectories showed that LVEF in the Re-worse group increased first 2 years and declined slowly thereafter (Fig. 1A). Re-worsening LVEF occurred 4.5±2.2 years after initial LVEF recovery. Multivariate logistic regression analysis demonstrated that LGE area at baseline (Odds ratio: 1.09, 95% confidence interval (CI) 1.02–1.18, p=0.014) and Log brain natriuretic peptide (BNP) at initial LVEF recovery (Odds ratio: 1.53, 95% confidence interval (CI) 1.01–2.31, p=0.042) were independent predictors for Re-worsening LVEF. Kaplan Meier analysis demonstrated that the risk of cardiac events in the Re-worse group was significantly higher (hazard ratio: 3.93, 95% CI 1.49–10.36, p=0.006) than in the Improved group and lower risk than in the Not-improved group (hazard ratio: 0.28, 95% CI 0.12–0.62, p=0.002) (Fig. 1B).

Conclusion
Re-worsening LVEF occurred in 30% of patients in patients with recent-onset DCM. LGE area and BNP at initial LVEF recovery were independently associated with re-worsening LVEF after initial LVEF recovery.
Figure 1

Funding Acknowledgement
Type of funding source: None
Sex differences in ventricular remodeling and long-term heart failure outcomes following acute coronary syndrome
Authors: Adamson P , Verryt T , Frampton C.M , Troughton R , Doughty R.N , Richards A.M 
Published: November 2020

Abstract

Background
Compared with men, women are at increased risk of heart failure hospitalization following acute coronary syndrome (ACS).

Purpose
We sought to determine whether this increased hazard was associated with differing patterns in left ventricular (LV) remodeling over the first 12 months after ACS.

Methods
In a prospective multi-centre observational cohort study, 2,140 patients with ACS underwent echocardiography at 1, 4, and 12 months following the index event. Heart failure hospitalisation events were captured over a median 4.8 (IQR 3.4–6.5) years and relative risk compared between women and men using a multivariable Cox model adjusted for baseline demographics (age and systolic blood pressure) and echocardiographic variables (LV end diastolic and end systolic volumes, LV ejection fraction, interventricular septal wall thickness, and E/e') captured at baseline and 12 months.

Results
The 609 (28.5%) women were older (mean [SD] age 70 [12] versus 65 [12] years), had higher systolic blood pressure, demonstrated smaller increases in peak myocardial biomarkers, and were less likely to undergo coronary revascularization during the index admission (41.9% versus 62.0%; p&lt;0.001 for all). After indexing for body surface area, women had smaller LV end diastolic and end systolic volumes, greater LV ejection fractions, and greater septal wall thickness and diastolic filling pressure estimates (E/e' 14 versus 11; p&lt;0.001 for all). Diastolic volumes further diverged at 12 months (p=0.05) and septal wall thickness increased compared with men (p=0.016). In unadjusted and adjusted analyses women were at increased risk of future heart failure hospitalization (unadjusted HR 1.5, 95% CI 1.2–1.9, adjusted HR 1.6, 95% CI 1.1–2.4).

Conclusions
Women experience a more concentric remodeling pattern over the 12 months following ACS. Women remain at increased risk of long-term heart failure hospitalization after accounting for clinical and echocardiographic characteristics.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): National Heart Foundation of New Zealand, New Zealand Health Research Council
The combined effect of Sacubitril-valsartan treatment on right ventricular function and cardiorespiratory response in patients with chronic heart failure
Authors: Chrysohoou C , Terzis I , Xanthopoulou M , Tzorovili E , Konstantinou C , Solomou E , Magkas N , Antoniou C.K , Xydis P , Dilaveris P , Tousoulis D 
Published: November 2020

Abstract

Cardiorespiratory response, right ventricular and global diastolic function is known to deteriorate the clinical course of patients with chronic heart failure with reduced ejection fraction (HFrEF), even under optimal treatment. In this work we sought to evaluate the impact of sacubitril/valsartan initiation in patients with chronic HFrEF in NYHA clinical status II-III, under optimal medical and invasive treatment. Methods 180 patients (85% male, mean age 62±9 years old, 60% ischemic heart failure, 73% with ICD, 45%with CRT and 45% with diabetes mellitus) in NYHA classification II-III-, who were prescribed Sacubitril-Valsartan were evaluated.
Clinical status, biochemical parameters, cardiorespiratory exercise response and bi-ventricular Doppler indices were evaluated at first visit and 6 months after. The pulsed tissue Doppler imaging of the systolic and diastolic function of mitral and tricuspid annulus was characterized by the systolic waves Smv and Stv, and the diastolic waves: Emv and Amv; E was the early filling wave in transmitral velocity. Left atrial maximal volume and global longitudinal strain of the left ventricle (GLPS) were measured. In cardiorespiratory exercise Vo2max, VE/VCO2 and Mets achieved were evaluated. All of them received b-blockers, 90% eplerenone or spironolactone, 25% ivabradine and 90% diuretic treatment. Seventy percent of them started with the dose of 50mg of sacubitril/valsartan; while 80% finally received the full dose of 200 mg bid. One third of them were on clinical status NYHA III.

Results
Eight of the patients discontinued the medication due to hypotension or renal function worsening. All patients expressed improvement in clinical status; while diuretic therapy was down titrated in all of them and discontinued in 30%. As compared with the initial examination, tricuspid annulus systolic wave velocity increased by 5% (p=0.04); maximum volume of left atrium was decreased by 6% (p=0.004); GLPS average was improved by 41% (p=0.001) and E/Emv ratio was decreased by 22% (p=0.04). Moreover, improvement in Stv was more prominent in DCM as compared to IHF patients; In cardio respiratory exercise VE/VCO2 decreased by 5% (p=0.05); while VO2 max showed a trend in improvement (p=0.06), with no difference detected between DCM and ICM patients; although there was a significant increase (47%) in METS achieved (p=0.02).

Conclusion
Sacubitril/valsartan initiation was associated with improved left diastolic function and right ventricular function, along with functional status improvement in patients with HFrEF. These finding underline the beneficial role of sacubitril/valsartan initiation on the hemodynamic course of patients with systolic heart failure and clinical status deterioration.

Funding Acknowledgement
Type of funding source: None