bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of simple nutrition index on the long-term mortality of acute decompensated heart failure patients with preserved left ventricular ejection fraction: insight from PURSUIT-HFpEF registry
Authors: Kikuchi A , Yamada T , Watanabe T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kawai T , Seo M , Yasumura Y , Hayashi T , Yano M , Hikoso S , Sakata Y 
Published: November 2020

Abstract

Background
The novel nutrition index; triglyceride (TG) × total cholesterol (TG) × body weight (BW) index (TCBI) has been reported to be an easy and useful predictor for patients with coronary artery disease. However, there is no information available on the prognostic value of TCBI in patients with heart failure with preserved LVEF (HFpEF) who admitted with acute decompensated heart failure (ADHF).

Methods and results
Data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study. PURSUIT-HFpEF study is a prospective multicenter observational study in which collaborating hospitals recorded clinical, echocardiographic, and outcome data of ADHF pts with HFpEF. We enrolled consecutive 757 HFpEF patients who admitted with ADHF from June 2016 to June 2019. TCBI was calculated by the formula; TG × TC × BW / 1000 at the discharge. After we excluded patients with in-hospital death or without sufficient data, we analyzed 419 patients. The primary endpoint was all-cause mortality. During a median follow up period of 1.1 (0.9–1.9) years, 59 patients died. ROC analysis revealed that TCBI at discharge was a fair discriminator for predicting all-cause mortality (AUC 0.676, sensitivity 53%, specificity 78%). Multivariate Cox proportional analysis showed that TCBI (p=0.002) was an independent predictor for all cause death after adjustment with major confounders such as age, gender, NT-proBNP, hemoglobin and serum creatinine level. We divided patients into 4 groups according to quartiles of TCBI. Kaplan-Meier analysis showed a significantly higher risk of all-cause death in relation to the decrease in TCBI.

Conclusion
TCBI, a simple and novel nutrition index, is a useful and strong long-term prognostic indicator in ADHF patients with HFpEF.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Roche Diagnositics K.K.; Fuji Film Toyoma Chemical Co. Ltd.
Prognostic impact of free-fat mass index on elderly patients with acute decompensated heart failure: from CURE-HF registry
Authors: Kanai M , Motoki H , Okano T , Kimura K , Minamisawa M , Yoshie K , Kato T , Saigusa T , Ebisawa S , Okada A , Kuwahara K 
Published: November 2020

Abstract

Background
Free-Fat Mass Index (FFMI) is an indicator of malnutrition and sarcopenia. We hypothesized that low FFMI would be associated with worse prognosis in elderly patients with heart failure.

Methods
In 800 patients who discharged after treatment for HF were prospectively enrolled from 13 medical centers. Free-Fat Mass Index was calculated dividing the square of the patients heights in meters into lean body mass. All-cause mortality (cardiovascular, non-cardiovascular) was followed-up by telephone interview and chart review.

Results
In our study cohort (median age, 78 [range 72–87]), FFMI was 16.7 [15.2, 18.0]. All-cause mortality was observed in 211 patients during 631 [266, 983] days follow-up. In Kaplan-Meier analysis, lower FFMI was associated with all-cause mortality. Furthermore, FFMI was an independent predictor of mortality after adjustment for age, gender, albumin, hemoglobin, creatinine, brain natriuretic peptide, and left ventricular ejection fraction (HR 95% CI: 0.841 (0.745–0.944), p=0.004). In subgroup analysis, low FFMI was associated with both cardiac and non-cardiac mortality in patients with HF with reduced ejection fraction (EF) (Log-rank p=0.002, p=0.013, respectively) (Figure). Furthermore, low FFMI was significantly associated non-cardiac death in patients with preserved EF (Log-rank p=0.033) (Figure).

Conclusions
Free-Fat Mass Index was significantly associated with mortality in elderly patients with HF.

Funding Acknowledgement
Type of funding source: None
Diagnosing heart failure from chest X-ray images using deep learning
Authors: Matsumoto T , Kodera S , Shinohara H , Kiyosue A , Higashikuni Y , Akazawa H , Komuro I 
Published: November 2020

Abstract

The development of deep learning technology has enabled machines to achieve high-level accuracy in interpreting medical images. While many previous studies have examined the detection of pulmonary nodules and cardiomegaly in chest X-rays using deep learning, the application of this technology to heart failure remains rare. In this study, we investigated the performance of a deep learning algorithm in terms of diagnosing heart failure using images obtained from chest X-rays. We used 952 chest X-ray images from a labeled database published by the National Institutes of Health. Two cardiologists respectively verified and relabeled these images, for a total of 260 “normal” and 378 “heart failure” images, and the remainder were discarded because they had been incorrectly labeled. In this study “heart failure” was defined as “cardiomegaly or congestion”, in a chest X-ray with cardiothoracic ratio (CTR) over 50% or radiographic presence of pulmonary edema. To enable the machine to extract a sufficient number of features from the images, we used the general machine learning approach called data augmentation and transfer learning. Owing mostly to this technique and the adequate relabeling process, we established a model to detect heart failure in chest X-ray by applying deep learning, and obtained an accuracy of 82%. Sensitivity and specificity to heart failure were 75% and 94.4%, respectively. Furthermore, heatmap imaging allowed us to visualize decisions made by the machine. The figure shows randomly selected examples of the prediction probabilities and heatmaps of the chest X-rays from the dataset. The original image is on the left and its heatmap is on the right, with its prediction probability written below. The red areas on the heatmaps show important regions, according to which the machine determined the classification. While some images with ambiguous radiolucency such as (e) and (f) were prone to be misdiagnosed by this model, most of the images like (a)–(d) were diagnosed correctly. Deep learning can thus help support the diagnosis of heart failure using chest X-ray images.
Heatmaps and probabilities of prediction

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): JSPS KAKENHI
Quantifying inflammation using interleukin-6 for improved phenotyping and risk stratification in acute heart failure
Authors: Michou E , Wussler D , Belkin M , Strebel I , Kozhuharov N , Sabti Z , Nowak A , Lopez Ayala P , Flores D , Gualandro D , Breidthardt T , Mueller C 
Published: November 2020

Abstract

Background
Acute heart failure (AHF) is the most common cause of hospital admission and continues to have unacceptable high rates of mortality and morbidity. In contrast to acute myocardial infarction, the pathophysiology of AHF is incompletely understood and risk-prediction is poorly defined.

Aim
We aimed to quantify systemic inflammation to assess its possible role in the pathophysiology and risk stratification of patients with AHF.

Methods
Using a novel Interleukin-6 immunoassay with unprecedented sensitivity (limit of detection 0.01ng/l) we quantified systemic inflammation in unselected patients presenting with acute dyspnea to the emergency department in a multicenter study. Plasma concentrations of NT-proBNP (open label) and Interleukin-6 (blinded) were measured at presentation and at discharge. The final diagnosis of AHF and the AHF phenotype were adjudicated by two independent cardiologists. 1-year mortality was the prognostic endpoint.

Results
Among 2042 patients, 1026 (50.2%) had an adjudicated diagnosis of AHF. Interleukin-6 concentrations were significantly higher in AHF patients compared to patients with other causes of dyspnoea (11.2 [6.1–26.5] ng/l vs 9.0 [3.2–32.3] ng/l, p&lt;0.0005). Among patients with AHF Interleukin-6 concentrations were elevated (&gt;4.45ng/l) in 83.7% of them. Among the different AHF phenotypes, Interleukin-6 concentrations were highest in patients with cardiogenic shock (25.7 [14.0–164.2] ng/l) and lowest in patients with hypertensive HF (9.3 [4.8–21.6] ng/l, p=0.001). Inflammation as quantified by Interleukin-6 was a strong predictor of 1-year mortality both in AHF as well as in other causes of acute dyspnea (Figure). During in-hospital treatment Interleukin-6 concentrations significantly decreased in AHF patients. However, changes in the extend of systemic inflammation (delta Interleukin-6) were poorly correlated with changes in hemodynamic stress as quantified by NT-proBNP (delta NT-proBNP, Φc=0.11, p=0.004).

Conclusions
An unexpectedly high percentage of patients with AHF have subclinical systemic inflammation that can be quantified by Interleukin-6, which seems to contribute to the AHF phenotype and to the risk of death.
Kaplan Meier curves for mortality

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Swiss National Science Foundation, Swiss Heart Foundation, European Union, Stiftung für kardiovaskuläre Forschung Basel, University of Basel, University Hospital Basel
Bedside ultrasound assessments of jugular venous compliance to track central venous pressure change during the treatment of decompensated heart failure
Authors: Fatima S , Lambert W , Nouraie S , Simon M , Pacella J 
Published: November 2020

Abstract

Background
Accurate volume status assessment is crucial for the treatment of acute decompensated heart failure (ADHF). Volume status assessment by physical exam is inaccurate, necessitating invasive measurement with right heart catheterization (RHC), which carries safety, pragmatic (scheduling, holding anticoagulants, etc) and financial burdens. Therefore, a reliable, non-invasive, cost-effective alternative is desired. Previously, we developed an ultrasound (US) based technique to measure internal jugular vein (IJV) compliance during RHC which was used for single time point central venous pressure (CVP) predictions. We now aim to apply this technique to track acute changes in CVP during diuresis for ADHF in patients with an in-dwelling pulmonary artery catheter.

Purpose
The objective of our study was to devise a rapid, portable and reliable alternative to RHC to track acute volume changes during treatment of ADHF.

Methods
We used an observational, prospective study design and recruited 15 patients from the CCU between 7/19–12/19 being treated for ADHF (systolic or diastolic) with IV diuretics +/−inotropic agents who underwent PA catheter insertion for continuous CVP monitoring. 13 of 15 patients received milrinone infusions. US images of the IJV were obtained at end expiration and during the strain phase of Valsalva at multiple 2–3 hr intervals. Change in IJV cross sectional area (ImageJ) was used as a measure of IJV compliance. Patients unable to perform the Valsalva maneuver and on mechanical circulatory support were excluded.

Results
Calculated % change in CSA of IJV was plotted against CVP. An inverse relationship was observed between CVP and % change in CSA of IJV. The data was fit with an inverse exponential regression shown in Figure 1 (R2=0.36, root mean square error = 3.19). Fivefold cross validation showed a stable model for predicting CVP based CSA (R2=0.34, root mean square error = 3.26)

Conclusion
Serial portable US assessment of IJV compliance can act a surrogate measure of CVP and,therefore, can provide reliable information on acute hemodynamic changes in ADHF.

Funding Acknowledgement
Type of funding source: None
Effect of comprehensive vasodilation vs usual care on mortality and heart failure rehospitalization in women with acute heart failure
Authors: Wussler D , Walter J , Kozhuharov N , Goudev A , Flores D , Maeder M , Shrestha S , Gualandro D , De Oliveira M.T , Kobza R , Rickli H , Breidthardt T , Muenzel T , Erne P , Mueller C 
Published: November 2020

Abstract

Background
Guidelines recommend evaluating the risk/benefit ratio of novel therapies individually in women and men, as the pathophysiology and the response to treatment may differ between women and men. Among patients with acute heart failure (AHF), a strategy of intensive vasodilation, compared with usual care, overall did provide comparable outcomes.

Purpose
To evaluate the effect of a strategy that emphasized early intensive and sustained vasodilation in women with AHF.

Methods
In a randomized, open-label blinded-end-point trial patients hospitalized for AHF were enrolled in 10 hospitals in Switzerland, Bulgaria, Germany, Brazil, and Spain. Inclusion criteria were AHF expressed by acute dyspnea and increased plasma concentrations of natriuretic peptides, systolic blood pressure ≥100mmHg, and a plan for treatment in a general ward. Patients were randomized 1:1 to a strategy of early intensive and sustained vasodilation throughout the hospitalization or usual care. The primary end point was a composite of all-cause mortality or rehospitalization for AHF at 180 days.

Results
Among 788 patients randomized, 781 completed the trial and were eligible for the primary end point analysis. Of these 288 (36.9%) were women. The primary end point, a composite of all-cause mortality or rehospitalization for AHF at 180 days, occurred in 53 female patients (37.9%) in the intervention group (including 28 deaths [20.0%]) and in 34 female patients (23.0%) in the usual care group (including 22 deaths [14.9%]) (absolute difference for the primary end point, 14.9%; adjusted hazard ratio, 1.67 [95% CI: 1.08–2.59]; P=0.02). Clinically significant adverse events with early intensive and sustained vasodilation vs usual care included hypotension (8% vs 2%).

Conclusion
Among women with AHF, a strategy of early intensive and sustained vasodilation, compared with usual care, had a detrimental effect on a composite outcome of all-cause mortality and AHF rehospitalization at 180 days.
Cox Proportional Hazard Curve

Funding Acknowledgement
Type of funding source: None
Is primary graft failure still a challenge in time of venoarterial extracorporeal membrane oxygenation?
Authors: Borderias T , Gonzalez Lizarbe S , Sanchez J , De Tapia B , Catoya S , Cabrera I , Molina M , Lozano M , Lujan E , Canteli A , Castrillo C , Ruiz Lera M , Sarralde J.A , Cobo M , Burgos V 
Published: November 2020

Abstract

Introduction
Primary graft failure (PGF) is the leading cause of early mortality after heart transplantation (HT). Its increasing incidence during the last decade may be triggered by the disbalance between receptors and donors that forces the acceptance of suboptimal organs.

Purpose
The aim of our work was to analyse the mechanical circulatory support (MCS) with VA-ECMO in refractory to inotropes PGF and determinate its impact in terms of graft function recovery and survival.

Methods
A retrospective study, analyzing our database of circulatory assist devices between 2009 and 2019. During this period, 252 devices have been implanted (154 ECMOs and 98 ventricular assist devices) and 201 patients have received a HT. We describe the characteristics and evolution of all PGF cases managed with VA-ECMO.

Results
Thirty nine patients (19.4%) developed PGF, defined as significant left, right or biventricular systolic dysfunction in the first 24 hours after HT, associated with hemodynamic instability and requiring high dose of inotropes, intra-aortic balloon pump (IABP) or VA-ECMO. Twenty two cases (56.4%) underwent a VA-ECMO implantation by peripheral cannulation as a bridge to recovery.
The median age was 50.8 (44.3–57.3) years and 77% were male. Biventricular dysfunction was observed in 50% and isolated right ventricular dysfunction in the remaining 50%. At the time of implantation, 59% had IABP and the median of inotropic score was 24 (8–40). Two complications occurred during implantation (one because of a complex vascular access and one due to a malposition of the venous cannula). Anticoagulation was started after a median of 19 hours (10–28; 59% sodic heparin and 36% bivalirudin).
The median support duration was 6.2 days (3–9.2). Graft function was recovered in 90%, making it possible to withdraw the device successfully in 82% of patients. The remaining 18% deceased during the support (2 because of multiorgan failure and 2 due to absence of function recovery).The median hospital length of stay was 63 days (33–93) and hospital and 1-year survival was 68.1%.

Conclusion
The support with VA-ECMO allowed graft function recovery in 90% of severe PGF cases, with a similar survival rate to other centres with MCS. In a scenario with a mortality rate superior to 50%, the MCS programs have managed to increase survival, avoid retransplantation in times of donor shortage and handle the use of suboptimal donors with better chances of success.

Funding Acknowledgement
Type of funding source: None
Do psychosocial factors affect readmission in heart failure patients? A single centre study in a veteran population in south Florida, USA
Authors: Mahabir S , Kittipibul V , Zarrabian B , Alarcon-Calderon A , Olarte N , Marzouka G , Palacio A 
Published: November 2020

Abstract

Background
We aim to determine the influence of psychosocial factors on readmission rates in a south Florida hospital serving a largely minority Veteran population with unique psychosocial co-morbidities that impact their health care.

Purpose
We aim determine which psychosocial factors are predictors of readmission in patients with heart failure (HF).

Methods
This is a retrospective study conducted at the Miami Veteran Affairs Medical Center (VAMC) in South Florida, USA. Patients who were admitted for heart failure exacerbations from September 2018 to August 2019 were identified and included in this study. Data on baseline charateristics and co-morbidities was obtained from review of patients' electronic health records. Psychosocial assessment was done via telephone interview using a previously validated questionnaire on gender, self-reported ethnicity, level of education, marital status, employment status, homelessness, monthly financial strain, overall stress level, neighbourhood safety and social interaction. Perceived health competence was assessed with the two items Perceived Health Competence Scale (PHCS-2).

Results
We identified 185 patients during the study period (mean age 70.8±11.9 years, 98% male). Thirty-eight of these patients had one or more readmissions within one year. Our cohort was 22% White, 15% Hispanic and 60% African American based on self-reported race. We interviewed 78 patients; 14 with readmission, 64 without readmission. 21% had died at the time of our follow-up and we were unable to contact 27% of patients. On univariate analysis, homelessness and ejection fraction (LVEF) ≤40% were significantly associated with HF readmission (OR 8.3 p=0.002 and OR 6.8 p=0.008, respectively). No significant differences in other psychosocial characteristics were noted between groups. After adjustment for age in multivariate analysis, homelessness and LVEF &lt;40% remained significant predictors for HF readmission (OR 13.4 p=0.005 and OR 8.8 p=0.02, respectively).

Conclusions
Our study population was largely a minority population (15% Hispanic and 60% African American). After comparing multiple psychosocial factors, homelessness was found to be a significant and independent risk factor for heart failure readmission. This suggests that the recent focus on heart failure readmissions may need to include social interventions targeting homelessness. Future research should aim to determine whether multidisciplinary interventions aimed at addressing homelessness in patients with heart failure would help reduce hospital readmissions for congestive heart failure.

Funding Acknowledgement
Type of funding source: None
Risk of heart failure associated with thiazide diuretics compared with calcium channel blockers in patients with type 2 diabetes: a nationwide nested case-control study
Authors: Malik M.E , Andersson C , Feifel J , Gerds T.A , Zareini B , Malmborg M , Lund-Kristensen S , Lamberts M , Koeber L , Torp-Pedersen C , Gislason G , Schou M 
Published: November 2020

Abstract

Background
Thiazide diuretics and calcium channel blockers (CCB's) are two important and widely used antihypertensive drugs classes among patients with type 2 diabetes (T2D). The risk of developing heart failure (HF) is increased in patients with T2D but whether use of these two drugs are associated with changes in HF risk is unknown.

Purpose
To examine and compare the association of two different classes of antihypertensive drugs, thiazide diuretics and CCB's, with the development of new onset HF in patients with T2D.

Methods
The study cohort comprised T2D patients &gt;40 years on metformin and renin-angiotensin system inhibitor (RAS-i) without a history of HF or use of loop diuretics identified in Danish health care registers (period 1995 to 2015). A nested case-control study was conducted by matching all HF cases on sex, age and duration of T2D with 10 controls from the T2D population. Exposure was defined as three redeemed prescriptions of either a thiazide diuretic or a CCB up to 365 days before index, which corresponds to one year of antihypertensive therapy. Conditional logistic regression adjusted for comorbidities (atrial fibrillation, chronic obstructive pulmonary disease and anemia) was used to estimate and compare the treatment effect of thiazide diuretics and CCB's, with patients receiving neither of the two drugs as reference.

Results
The study population consisted of 170,514 T2D patients using metformin and RAS-i, comprising 13,814 HF cases each matched on sex, age and duration of T2D with 10 controls. The median age was 62 years and 55% were men. T2D patients, who had received antihypertensive treatment with only thiazide diuretics one year prior to index had a significantly lower risk of HF compared to the reference group who did not receive treatment with neither thiazide diuretics or CCB's: Hazard ratio (HR) 0.79 [95% confidence interval (CI) 0.74–0.85]. Patients who had received treatment with only CCB's had a comparable risk of HF: HR 0.98 [95% CI 0.94–1.02]. Patients who had received treatment with both thiazide diuretics and CCB's were not associated with a lower risk of HF: HR 1.01 [95% CI 0.96–1.08].

Conclusion
Patients with T2D who received antihypertensive therapy with thiazide diuretics for at least one year had a significantly lower risk of HF compared to those who were not treated with either thiazide diuretics or CCB's. No association between use of CCB's and HF was observed. Use of thiazide diuretics may prevent development of HF in T2D and a randomized clinical trial evaluating diuretics is patients with T2D is warranted.
Risk of new onset heart failure

Funding Acknowledgement
Type of funding source: None