bluuebunny/crossref_metadata_2025_split huggingface dataset:
Very early detection of low dose anti-cancer therapy-related cardiotoxicity in lymphoma patients
Authors: Liu Y.W , Chang H.Y , Lee C.H , Tsai W.C , Liu P.Y , Chen T.Y 
Published: November 2020

Abstract

Background and purpose
Left ventricular (LV) global peak systolic longitudinal strain (GLS) by speckle-tracking echocardiography is a sensitive modality for the detection of subclinical LV systolic dysfunction and a powerful prognostic predictor. However, the clinical implication of LV GLS in lymphoma patients receiving anti-cancer therapy remains unknown.

Methods
We prospectively enrolled 74 patients (57.9±17.0 years old, 57% male) with lymphoma who underwent echocardiography prior to chemotherapy, post 3rd and 6th cycle and 1 year after chemotherapy. Cancer therapy-related cardiac dysfunction (CTRCD) is defined as the reduction of absolute GLS value from baseline of ≥15%. All the eligible patients underwent a cardiopulmonary exercise test (CPET) upon completion of 3 cycles of anti-cancer therapy. The primary outcome was defined as a composite of all-cause mortality and heart failure events.

Results
Among 36 (49%) patients with CTRCD, LV GLS was significantly decreased after the 3rd cycle of chemotherapy (20.1±2.6% vs. 17.5±2.3%, p&lt;0.001). In the multivariable analysis, male sex and anemia (hemoglobin &lt;11 g/dL) were found to be independent risk factors of CTRCD. Objectively, patients with CTRCD had lower minute oxygen consumption/kg (VO2/kg) and lower VO2/kg value at anaerobic threshold in the CPET. The incidence of the primary composite outcome was higher in the CTRCD group than in the non-CTRCD group (hazard ratio 3.21; 95% CI, 1.04–9.97; p=0.03).

Conclusion
LV GLS is capable of detecting early cardiac dysfunction in lymphoma patients receiving anti-cancer therapy. Patients with CTRCD not only had a reduced exercise capacity but also a higher risk of all-cause mortality and heart failure events.
Change of LVEF and GLS after cancer Tx

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): The Ministry of Science and Technology (MOST), Taiwan
Incidence of atrial fibrillation in cancer patients according to cancer type
Authors: Yang P.S , Shim M , Kang S.H , Kim S.H , Kim W.J , Moon J.Y , Sung J.H , Kim I.J , Lim S.W , Cha D.H , Lip G.Y.H , Joung B 
Published: November 2020

Abstract

Background and objectives
The prevalence of both atrial fibrillation (AF) and cancer are increasing especially in the elderly. The occurrence of AF in cancer may be related to comorbidities of patients, cancer treatment, or a direct tumor effect. The objectives of this study were to investigate the incidence of AF according to cancer type.

Methods
From the Korean National Health Insurance Service elderly (NHIS-elderly) cohort (age &gt;60), we identified 67,077 patients with newly diagnosed cancer and without previous AF. Incidence rates of new onset AF were evaluated.

Results
The mean age of the cancer patients was 75.1 year and 53.5% were males. During a median follow-up period of 25 months, the incidence rate of AF among overall cancer patients was higher than that of age-sex matched non-cancer population (1.42 vs. 0.69 per 100 person-years, respectively). Compared with solid cancer, the risk of incident AF in patients with hematologic cancer was significantly higher (hazard ratio [HR]: 1.53, 95% confidence interval [CI]: 1.39–1.72, p&lt;0.001). Among patients with solid cancer, thoracic (lung cancer, esophageal cancer, mediastinal cancer, etc.) and breast cancer was associated with a higher risk of AF incidence compared with other solid cancer (HR: 1.64, 95% CI: 1.53–1.76, p&lt;0.001).

Conclusions
Cancer was associated with an increased incidence of AF. Hematologic cancer was associated with higher risk of AF incidence than solid cancer. Among solid cancer, thoracic and breast cancer was most strongly associated with the risk of AF incidence.

Funding Acknowledgement
Type of funding source: None
Efficacy and safety of catheter ablation for atrial fibrillation in patients with cancer
Authors: Ganatra S , Abraham S , Parikh R , Kamenetsky D , Patel R , Dani S , Chaudhry G , Resnic F , Shah S , Venesy D , Patten R , Neilan T , Reynolds M , Hook B , Nohria A 
Published: November 2020

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia in patients with cancer. Management of AF in patients with cancer poses unique challenges. Long-term use of antiarrhythmic drug (AAD) therapy lacks evidence of efficacy in this population and poses risk of drug interactions. Catheter ablation is a well-established treatment modality for AAD resistant symptomatic AF and in patients with heart failure. Nevertheless, the effectiveness and safety of catheter ablation in patients with cancer is not well established.

Method
We retrospectively analyzed consecutive patients who underwent catheter ablation for AF, with either history of cancer (other than non-melanoma skin cancer) within 5-years prior or exposure to systemic anthracycline and/or thoracic radiation therapy at any time.

Results
The study included 162 patients. The mean age was 65.5 (26–84 years) years and 50% were female. Overall 133 (82%) patients had freedom from AF at 12 months following ablation. Of these 74 (54%) required post-ablation AAD, 18 (13.5%) required another ablation within the first 12 months and 9 (6.7%) required both AAD and a second ablation to maintain sinus rhythm. There were 14 adverse events (8.6%); 5 access site and 4 non-access site bleeding, 2 strokes, 2 cardiac tamponade and 1 pulmonary vein stenosis with ≈1% serious complications.

Conclusion
The success of catheter ablation for AF and the incidence of procedure related complications in patients with a history of recent cancer or prior exposure to cardiotoxic therapies are similar to that reported in patients without a history of cancer and hence if needed, it should be considered in select patients.

Funding Acknowledgement
Type of funding source: Private hospital(s). Main funding source(s): Dr. S Ganatra is supported by Lahey Physician Research Stipend Program.
Pregnancy outcomes in women with mechanical heart valves
Authors: Ferreira V , Viveiros Monteiro A , Plancha Santos M , Patricio L , Borges A , Machado A , Castelo A , Garcia Bras P , Mano T , Cardoso I , Grazina A , Alves M.J , Cruz Ferreira R 
Published: November 2020

Abstract

Background
Mechanical heart valves (MHV) and their absolute need for adequate anticoagulation poses a challenge for pregnancy, either due to warfarin fetotoxicity or an increased risk of maternal thromboembolism. This represents a unique patient (P) group where data is scarce and maternal and fetal risks and benefits must be carefully weighed.

Purpose
To assess maternal and perinatal outcomes in women with MHV on different anticoagulant regimens and compare them with patients with other types of valvular heart disease (VHD).

Methods
A retrospective analysis of 131 pregnancies in 83 women with VHD (mean age 26.5±5.6 years) was carried out in a tertiary referral centre from 2000 to 2019. 92 pregnancies with VHD, including 11 with biological prosthetic valves, and 39 pregnancies in 22 P with MHV were identified. The main outcome measures were major maternal complications and perinatal outcome.

Results
MHV implanted were in mitral position (89.7%), aortic (2.6%), or both (7.7%). History of rheumatic heart disease was identified in 16 P (72.7%) and a congenital etiology was present in 2 P (9.1%). 9 P (40.9%) were on warfarine and 13 P (59.1%) on acenocumarol. Regarding anticoagulation strategy, 21 P (65.6%) remained on oral anticoagulation and 10 P (31.3%) had been switched to some form of heparin during part or the entire pregnancy. Mechanical valve thrombosis complicated pregnancy in 4 patients (10.2%), all cases on heparin, and resulted in maternal death in 1 P. MHV P had more hemorrhagic complications (15.4 vs 2.2%, p=0.004) requiring transfusion or surgical revision. MHV P tended to experience more NHYA class worsening demanding initiation or intensification of cardiac medication (17.9 vs 5.4%, p=0.023). Also in the MHV group there was a higher incidence of miscarriage (46.2 vs 12.0%, p≤0.0005), comprising spontaneous abortion (31.6 vs 7.6%, p&lt;0.0005) and fetal malformations (18.4 vs 5.4%, p=0.028), including warfarin embryopathy (10.3 vs 1.1%, p=0.012). The live birth rate was higher in women on heparin compared with those on warfarin (85.9 vs 79.2%, p=0.002). The presence of multivalve disease (p=0.04), mechanical protheses (p&lt;0.001), ACO (p&lt;0.001) and previous impaired LVEF (p=0.02) were related to miscarriage. In multivariate analysis, ACO was the unique independent predictor of unsuccessful pregnancy (p=0.01). Only 29% of the patients with an MHV had a pregnancy free of serious adverse events compared with other types of VHD (81.5%, p&lt;0.0005).

Conclusions
MHV remains a challenging condition for pregnancy with only 29% chance of experiencing an uncomplicated pregnancy with a live birth. The increased morbimortality warrant extensive prepregnancy counseling with prosthesis type discussion,centralization of care and further larger studies to come up with evidence-based recommendations.

Funding Acknowledgement
Type of funding source: None
Rates of permanent pacemaker implantation for complete heart block complicating pregnancy: a nationwide analysis of 20,451,108 pregnant patients in the USA
Authors: Gonuguntla K , Patil S.P , Rojulpote C , Borja Z.E , Bravo P.E , Nardino R.J 
Published: November 2020

Abstract

Introduction
Complete heart block (CHB), also known as third-degree heart block, occurs when there is complete dissociation of the atria and ventricles. CHB during pregnancy is extremely rare and one possible mechanism may be related to the stretching of the atria during pregnancy causing conduction defects

Purpose
There is limited data on the rates of CHB and pacemaker (PPM) use in pregnant patients, with only a few case reports published. In this study we sought to define the rates of permanent pacemaker implantation for CHB complicating pregnancy.

Methods
The Nationwide Inpatient Sample was queried from 2010 to 2014 using the International Classification of Diseases, 9th revision diagnosis codes for pregnancy and CHB and procedure codes for PPM in any procedure field for patients 18 years or older.

Results
From 2010 to 2014, we identified 20,451,108 pregnancies in patients above the age of 18 years. The overall rates of CHB were 643 (0.0031%). The sample consisted of 643 patients (Mage= 29.28±6.42 years) with CHB, the majority of whom were Caucasians 328 (51%). Average length of stay (LOS) (M ± SD) was 4.94±7.859 and total hospitalization charges were 51,715.04±112,345.98 ($). Moreover, the occurrence of other conditions which could lead to the development of CHB was: sarcoidosis 0 (0%), systemic lupus erythematosus 5 (0.8%), prior myocardial infarction 25 (3.8%), Lyme disease 0 (0%). Among patients with CHB, PPM implantation was done in 60 (9.3%), and TVP were 5 (0.8%). The overall composite mortality rates were 21 (3.2%). On comparing the non-PPM group to the PPM group, rates of in-hospital mortality were 3.6% vs 0%; p=0.059, LOS were 4.49±5.01 vs 12.50±15.35; p&lt;0.001, complications such as congestive heart failure 0% vs 8.4%; p&lt;0.001, cardiogenic shock 1% vs 8.4%; p&lt;0.001, respiratory failure needing mechanical ventilation 1.7% vs 0; p&lt;0.04, sudden cardiac death 3.4% vs 0; p&lt;0.05.

Conclusions
The overall rates of CHB were 3.1 in 100,000 pregnancies. There were no reported in-hospital deaths among pregnant patients with CHB who received PPM and TVP. Relatively lower rates of PPM implantation in these patients might indicate that CHB during pregnancy is less severe and patients may have a stable narrow complex junctional escape rhythm. PPM implantation is recommended for those who are symptomatic or have a slow wide QRS complex rhythm indicating a block below the bundle of His.With this study we attempt to better define the occurrence of CHB during pregnancy, which could lead to better understanding and management of this condition.

Funding Acknowledgement
Type of funding source: None
Differences in the clinical characteristics and long-term outcome of peripartum tako-tsubo cardiomyopathy and peripartum cardiomyopathy
Authors: Kim D , Kim S.R , Park S , Seo J , Kim E.K , Yang J.H , Chang S , Choi J , Lee S , Park S.W 
Published: November 2020

Abstract

Background
Some peripartum-associated cardiomyopathy patients present similarly to those of tako-tsubo cardiomyopathy (TCM), little is known about the clinical course of peripartum TCM.

Purpose
To know clinicial characteristics and outcomes of peripartum TCM, in comparison with peripartum cardiomyopathy (PPCM)

Methods and results
Of 31 pregnancy-associated cardiomyopathy patients in a tertiary hospital, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-missed death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 76.2%, p=0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricle (LV) dysfunction. LV ejection fraction greater than 30% on the initial echocardiogram independently predicted early echocardiographic recovery of left ventricular systolic function (odds ratio 331.33, 95% confidence interval 3.87–28402.60, p=0.011). There was no difference between the two groups in terms of the rate of adverse clinical events at 3 years of follow-up (PPCM group: 26.3% [5/19] vs. TCM group: 33.3% [3/9], p=0.750).

Conclusions
One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.
Kaplan-Meier survival curves for death,

Funding Acknowledgement
Type of funding source: None
HIV patients at the crossroads of European cardiovascular recommendations. Which path they should follow?
Authors: Sanetra A , Gorzelak-Pabis P , Wlazlowska E , Jablonowska E , Broncel M 
Published: November 2020

Abstract

Background/Introduction
Recently, HIV patients' life expectancy has been significantly improved due to HAART. It is estimated that HIV positive individuals experience twice the risk of cardiovascular diseases rather than a general population and suffer from cardiovascular incidents in mean age 46 years. However there is no consensus between cardiovascular recommendations for this group of patients.

Purpose
The aim of the study is the analysis of HIV patients in the light of different cardiovascular recommendations and thus highlighting the inaccuracies of guidelines for this specific group of patients.

Methods
We performed retrospective analysis of 388 HIV infected patients based on medical records. Then we confronted our patients with different cardiovascular recommendations (PTN AIDS and ESC/EAS 2019 Dyslipidemia Guidelines vs. EACS Guidelines 2019).

Results
HIV-positive patients included in the study were: 311 men (80.4%) and 77 women (19.6%) in average age 41.7±10 years. The average BMI was 25.3±5 kg. Average HIV infection time was 8.96±7 years. Mean antiretroviral (arv) treatment duration was 4.6±3 years. Eleven participants (2.8%) had ischemic heart disease, 23.5% had hypertension and 3.4% HIV patients were diabetics. Half of patients (50.3%) were active smokers. Fourteen HIV patients (3.6%) experienced cardiovascular incidents in mean age 41.8±6 years. The actual average LDL in those patients is 93.14±21 mg/dl and currently only one of them achieves therapeutic LDL. HIV patients in consideration of PTN AIDS and ESC/EAS 2019 Dyslipidemia Guidelines vs. EACS Guidelines 2019 were scheduled in the Table.

Conclusion(s)
HIV patients included in our study poorly reach therapeutic recommendations neither provided by ESC/EAS and PTN AIDS or EACS Guidelines. Therapeutic goals reachability is worse in patients on lipid lowering therapy which along with low mean doses of statins indicates that HIV patients hypolipemic treatment is insufficient. There is no consensus on European cardiovascular guidelines for HIV patients, and thus there is a huge gap between recommendations and clinical practice.

Funding Acknowledgement
Type of funding source: None
Effects of canagliflozin on cardiovascular death and hospitalization for heart failure by baseline estimated glomerular filtration rate: integrated analyses from the CANVAS Program and CREDENCE
Authors: Mahaffey K.W , Bakris G , Blais J , Cannon C.P , Cherney D , Damaraju C.V , Gogate J , Greene T , Heerspink H.J.L , Januzzi Jr J.L , Kosiborod M , Levin A , Lingvay I , Weir M , Perkovic V 
Published: November 2020

Abstract

Background
People with type 2 diabetes mellitus (T2DM) have a greater risk of cardiovascular (CV) disease, including hospitalization for heart failure (HHF), a complication that is more common as renal function declines. The sodium glucose co-transporter 2 (SGLT2) inhibitor canagliflozin (CANA) reduced the risk of HHF in patients with T2DM and high CV risk or nephropathy in the CANVAS Program and CREDENCE trials, respectively.

Methods
This post hoc analysis included integrated, pooled data from the CANVAS Program and the CREDENCE trial. The effects of CANA compared with placebo on CV death or HHF, HHF, and CV death were assessed in subgroups defined by baseline eGFR (&lt;45, 45–60, and &gt;60 mL/min/1.73 m2). Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models, with subgroup by treatment interaction terms added to test for heterogeneity. Interaction P values were calculated by including treatment group and baseline eGFR in the model.

Results
A total of 14,543 participants from the CANVAS Program (N=10,142) and CREDENCE (N=4,401) were included, with mean age, 65 y; 65% male; 75% white; mean eGFR 70.3 mL/min/1.73 m2. 1919 (13.2%) participants had baseline eGFR &lt;45 mL/min/1.73 m2 (mean, 36.7 mL/min/1.73 m2), 2972 (20.4%) participants had eGFR 45–60 mL/min/1.73 m2 (mean, 53.1 mL/min/1.73 m2), and 9649 (66.3%) participants had eGFR &gt;60 mL/min/1.73 m2 (mean, 82.3 mL/min/1.73 m2). Rates of CV death or HHF, HHF, and CV death increased as eGFR declined (Figure). CANA significantly reduced the risk of CV death or HHF and HHF compared with PBO, with consistent effects observed across subgroups.

Conclusions
CV death or HHF, HHF, and CV death event rates increased with lower baseline eGFR. CANA significantly reduced the risk of CV death or HHF, jointly and individually, in participants with T2DM and high CV risk or CKD in the CANVAS Program and the CREDENCE trial, with consistent benefits observed regardless of baseline eGFR.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Janssen Scientific Affairs, LLC
Natriuretic peptide as a predictor of adverse renal outcomes in patients with acute kidney injury
Authors: Chaikijurajai T , Demirjian S , Wu Y , Tang W 
Published: November 2020

Abstract

Background
Since cardiorenal syndrome has been increasingly recognised as the intense interaction between the heart and the kidneys, we hypothesised that in patients with acute kidney injury (AKI), a biomarker of cardiovascular stress and heart failure (HF), N-terminal pro-brain natriuretic peptide (NT-proBNP), can predict adverse renal outcomes.

Purpose
The purpose of this study was to investigate the ability of NT-proBNP to predict need for dialysis and dialysis dependence in patients with AKI.

Methods
We analysed the association between baseline NT-proBNP measured before renal consultation, and need for dialysis and dialysis dependence, using a cohort of 1,052 AKI patients admitted to the Cleveland Clinic between 2011 and 2016. AKI was defined as acute increase in serum creatinine (Cr) of at least 0.3 mg/dL or 50% from baseline. Dialysis dependence was defined as patients still need dialysis within 72 hours of discharge.

Results
Mean age was 65.8±13.6 years, 57% were male, 45.4% had chronic HF and 28.2% had chronic kidney disease (CKD). There was no significant difference in chronic HF, CKD, or baseline Cr between AKI patients with and without dialysis. Median NT-proBNP was 6,484.50 pg/mL (interquartile range 2,200.75–15,717.50 pg/mL). We observed that 43.1% had dialysis (among them 67.8% became dialysis dependence). After adjustment for age, gender, hypertension, and baseline Cr, higher NT-proBNP levels were associated with greater likelihood of needing dialysis [quartile (Q) 4 vs. 1, Odd ratio (OR) 1.98, 95% confidence interval (CI) 1.38–2.85, P&lt;0.001] and dialysis dependence (Q 4 vs. 1, OR 2.63, 95% CI 1.41–4.9, P=0.002) (Figure 1).

Conclusion
Elevated NT-proBNP was independently associated with need for dialysis and dialysis dependence in patients with AKI.
Figure 1

Funding Acknowledgement
Type of funding source: None
Coronary artery bypass grafting versus percutaneous coronary intervention for left main disease in chronic kidney disease patients: a meta-analysis
Authors: Jhand A , Bansal R , Dhawan R , Abbott J.D , Porter T , Tcheng J , Chatzizisis Y , Goldsweig A 
Published: November 2020

Abstract

Background
Limited data exist on the optimal revascularization strategy for patients with left main coronary artery disease (LMCAD) and chronic kidney disease (CKD). We conducted a meta-analysis to compare the outcomes of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) in this population.

Methods
Multiple electronic databases were queried for studies comparing CABG and PCI in CKD patients undergoing LMCAD (&gt;50% diameter stenosis) revascularization. CKD was defined as estimated glomerular filtration rate of &lt;60 ml/min/1.73 m2. The primary outcome was long-term major adverse cardiac and cerebrovascular events (MACCE), which was a composite of cardiovascular death, myocardial infarction (MI), stroke and repeat revascularization. Secondary outcomes included all-cause mortality, MI, stroke and repeat revascularization. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. The analysis was performed using the DerSimonian and Laird random effect model.

Results
Six studies (4 observational, 2 randomized controlled trials) met inclusion criteria with a total of 2051 patients (CABG: 977, PCI: 1074). Patients undergoing CABG had a higher incidence of multi-vessel disease (74.7% vs 65.7%, p=0.01). At a mean follow-up of 3.4±1.1 years, MACCE was significantly lower in the CABG group (OR = 0.70, 95% CI 0.57–0.87; p=0.001) (Figure 1). The odds of MI or repeat revascularization were lower with CABG, whereas the odds of stroke were higher; no statistically-significant difference was seen in all-cause mortality.

Conclusion
This meta-analysis shows that CABG is associated with lower rates of MACCE and MI but with a higher rate of stroke compared to PCI in LMCAD patients with CKD.

Funding Acknowledgement
Type of funding source: None