bluuebunny/crossref_metadata_2025_split huggingface dataset:
Performance of the padit score in patients undergoing transvenous lead extraction
Authors: Dias Ferreira Reis J.P , Valente B , Ferreira V , Castelo A , Portugal G , Monteiro A , Lousinha A , Silva Cunha P , Oliveira M , Cruz Ferreira R 
Published: November 2020

Abstract

Background
The PADIT trial identified 5 independent predictors of cardiac implantable electronic device (CIED) infection (prior procedure, age, chronic kidney disease, immunosuppression and type of procedure) and developed a novel infection risk score.

Aim
To assess whether the PADIT score (PS) could predict CIED reinfection and adverse events in patients (pts) submitted to transvenous lead extraction (LE) using the Pisa Technique (PT) due to CIED infection.

Methods
We conducted a single-centre prospective study of consecutive procedures (P) of LE using the PT between February 2013 and October 2019. Demographic, clinical, microbiological, device/ procedure related variables, morbidity and mortality data were retrieved during follow-up (FUP). An univariate analysis was performed to evaluate the ability of the PS to predict CIED reinfection (Re), procedural complications (C), all-cause hospital mortality (M), all-cause mortality/ hospitalization during first year of follow-up (MH1) and cardiovascular mortality (CM).

Results
A total 171 Ps including 159 pts, of which 80.7% (130 pts)were due to CIED infection: 55.1% due to pocket site infection, 18.8% to occult bacteremia with probable CIED infection and 26.1% due to both pocket site and systemic infection, with 44% of pts presenting with valvular/ lead vegetation (mean age - 70.3Y, 77.7% male, mean LVEF of 49.6%). The Rs rate was 93.1% and the clinical success rate was 99.2%. There were no deaths related to the procedure. During a mean FUP of 33 months, 11 pts had to undergo a new P, 5 of them due to pocket reinfection. The mortality rate was 24.2% (37 pts), with 8 pts dying during hospital stay, and 19 pts during the first year post-P. The mean PS was 2.9±2.5 (min- 0, max- 10). A higher PS value was associated with Re (HR - 1,43, CI95% 1.09–1.87, p=0.011), CM (HR - 1,39, CI95% 1.06–1.85, p=0.018) and MH1 (OR - 1,19, CI95% 1.03–1.38, p=0.021). There was no association between the PS and the rate of clinical success of the procedure (2.9% vs 4.5%, p=0.395), procedural complications (2.9% vs 3.3%, p=0.656) and M (4.0% vs 2.8%, p=0.192). Interestingly, a higher PS was not associated with a higher use of an antibacterial envelope during device reimplantation (3.5% vs 2.9%, p=0.371).

Conclusion
The PADIT score revealed a high predictive power for reinfection, all-cause mortality/ hospitalization during first year of follow-up and cardiovascular mortality in pts submitted to LE using the PT for CIED infection.

Funding Acknowledgement
Type of funding source: None
Leg raise can detect exercise-induced pulmonary arterial wedge pressure elevation
Authors: Nakata C , Goda A , Takeuchi K , Kikuchi H , Inami T , Soejima K , Satoh T 
Published: November 2020

Abstract

Background
Exercise-induced elevation of pulmonary arterial wedge pressure (PAWP) may show preclinical or exercise-induced left ventricular diastolic dysfunction. Invasive hemodynamic assessment during provocative maneuvers, like exercise and volume challenge, in these patients allows greater sensitivity to diagnose or exclude HFpEF. The aim of this study was to examine how the leg raise, which is a simple way to increase preload, can detect exercise-induced PAWP elevation.

Methods
Four hundred seventy-nine patients (60±14y.o, mean pulmonary arterial pressure (PAP) 19mmHg, PAWP 8mmHg, CTEPH /IPAH/CTD-PH/SOB unknown reason: 357/56/38/28pts) with near-normal PAP and normal PAWP at rest underwent symptom-limited exercise test using supine cycle ergometer with right heart catheter. Exercise-induced elevation in PAWP of over 20mmHg was defined as exercise-induced elevation group.

Results
ΔPAWP (after leg raise - rest) in the exercise-induced elevation group was significantly higher (6.0±4.1 vs. 2.7±3.9mmHg, p&lt;0.001, in the older (age≥60y.o) group (n=276); 3.4±3.5 vs. 1.9±3.4mmHg, p&lt;0.001, in the younger (age&lt;60y.o) group (n=203)) than that in the non-elevation group after legs raise for cycle ergometer exercise. The area under the ROC curve for ΔPAWP was 0.72 (95% CI: 0.65–0.78) in the older and 0.64 (95% CI: 0.53–0.75) in the younger. In the older, the cut-off value for detect exercise-induced PAWP elevation of ΔPAWP was 4mmHg, with 72% sensitivity and 58% specificity. On the other hand, in the younger, the cut-off value was 3mmHg, with 69% sensitivity and 59% specificity.

Conclusion
Leg raise can easily detect occult left ventricular diastolic dysfunction.

Funding Acknowledgement
Type of funding source: None
Sacubitril/valsartan and circulating neprilysin hypothesis in patients with HFpEF
Authors: Santiago-Vacas E , Codina P , Domingo M , De Antonio M , Zamora E , Santesmases J , Julian M.T , Diez-Quevedo C , Troya M.I , Boldo M , Altimir S , Nunez J , Gonzalez B , Lupon J , Bayes-Genis A 
Published: November 2020

Abstract

Background
Neprilysin serum levels (sNEP) exhibited significant prognostic value in patients with heart failure (HF). In the PARADIGM-HF study benefit of sacubitril/valsartan was observed in patients with reduced ejection fraction (HFrEF), while in the PARAGON-HF benefit was only observed in the subgroup of patients with LVEF &lt;57%.

Objective
To assess the prognostic value of sNEP in ambulatory patients with HF and preserved ejection fraction (HFpEF) and LVEF &gt;57% (group 1), in comparison with patients with LVEF ≤57% (group 2).

Methods
Consecutive patients with HF attended at the Unit from May 2006 to February 2016 were considered for the study. The primary end-point was the composite of cardiovascular death or HF hospitalization. All-cause death, cardiovascular death, HF hospitalization and the composite of all-cause death or HF hospitalization were secondary end-points. Competing risk methods (R package by Bob Gray for SPSS) were used when required.

Results
sNEP was measured in 1428 patients (age 67.7±12.7, 70.3% men, LVEF 35.8% ±14, 48.9% from ischemic etiology), 144 of which had a LVEF &gt;57% (age 70.1±15, 43.8% men, 53.5% from hypertensive or valvular etiologies). sNEP levels did not significantly differ between the two groups of patients (p=0.31). During a mean follow-up of 6±3.9 years, 856 deaths were recorded (459 from cardiovascular causes) and 523 patients suffered at least one HF hospitalization. The primary end-point occurred in 941 patients (in 111 of the 144 patients with LVEF &gt;57%). Table 1 shows sNEP age- and sex-adjusted hazard ratios for the primary and secondary end-points.

Conclusions
sNEP prognostic value in patients with HFpEF and LVEF &gt;57% outperforms that observed in patients with lower LVEF. These data support the personalized use of sNEP in identifying HFpEF patients that may benefit from treatment with sacubitril/valsartan.

Funding Acknowledgement
Type of funding source: None
Lung ultrasound in patients with suspected HFpEF
Authors: Malek J , Vecera J , Kubrycht M , Matejka J , Vojtisek P 
Published: November 2020

Abstract

Purpose
The aim of the present study was to test correlation of laboratory, echocardiographic and clinical parameters with recently developed scores for HFpEF diagnostics in patients with exertional dyspnea and preserved ejection fraction.

Methods
We performed rest and stress echocardiography, rest and peak exercise B-lines count assessed by 8 zone LUS, cardiopulmonary exercise test and laboratory testing in 47 patients (age 62,6±92 years; 57,4% females) refferred for exertional dyspnea. H2FPEF and HFA-PEFF score was calculated for each patient.

Results
H2FPEF score correlated significantly with rest B-lines count (r=0,350, p=0,016). We observed negative correlation of H2FPEF with peak workload (r=−0,558, p&lt;0,001) and peakVO2 (r=−0,519, p&lt;0,001). HFA-PEFF score correlated with peak workload (r=−0,468, p&lt;0,001) and peakVO2 (r=−0,403, p=0,009). No correlation of B-lines count with HFA-PEFF score was observed. We also observed significant correlation of HFA-PEFF and H2FPEF (r=0,545, p&lt;0,001).
HFpEF was diagnosed in 17 patients according to ESC guidelines. Patients with HFpEF had higher HFA-PEFF score (4,0±1,1 vs 1,9±1,4; p&lt;0,001) and H2FPEF score (4,2±1,8 vs 2,2±1,8; p&lt;0,001) and lower peakVO2 (17,0±4,8 ml/kg/min vs 22,9±5,6 ml/kg/min; p=0,001) and workload (1,3±0,4 W/kg vs 1,8±0,6 W/kg; p=0,002). B-lines count was similar in HFpEF patients and rest of population.

Conclusion
According to our data it seems that recently developed scores HFA-PEFF and H2FPEF would be more useful for HFpEF diagnostics than B-lines scoring.

Funding Acknowledgement
Type of funding source: None
Long-term outcome of minimally invasive mitral valve annuloplasty in disproportionate mitral regurgitation
Authors: Albano M , Nagumo S , Vanderheyden M , Bartunek J , Collet C , Balogh Z , Katbeh A , Kodeboina M , Van Camp G , Penicka M 
Published: November 2020

Abstract

Background
Hypothetical concept of disproportionate secondary mitral regurgitation (SMR) has been recently introduced to facilitate patient's selection for mitral valve intervention. However, real world data validating this concept are unavailable.

Purpose
To investigate long-term effects of minimally invasive mitral valve annuloplasty (MVA) in patients with disproportionate (dSMR) versus proportionate SMR.

Methods
The study population consisted of 44 consecutive patients (age 67±9,5 years; 64% males) on guidelines-directed therapy with advanced heart failure (HF), reduced LV ejection fraction (EF) (32±9,7%) and SMR undergoing isolated mini-invasive MVA. Patients with organic mitral regurgitation or concomitant myocardial revascularization were excluded. To assess SMR disproportionality, the PISA-derived effective regurgitant orifice area (EROA) and regurgitant volume (RV) were compared to the estimated EROA and RV by using Gorlin formula and pooled real world data.

Results
According to EROA, a total of 20 (46%) and 24 (54%) patients, respectively, had dSMR and proportionate SMR (pSMR). According to RV, a total of 17 (39%) had dSMR and 27 (61%) had pSMR. Patients with dSMR showed significantly lower prevalence of male gender and higher prevalence of diabetes mellitus than patients with pSMR (p&lt;0,001). Moreover, we observed smaller LV end-diastolic volume, larger EROA and RV (both p&lt;0,01) and higher LV EF (p=0,02) in the dSMR versus the pSMR group. Other baseline characteristics were similar. During median follow up of 4.39 y (IQR 2,2–9,96y), a total of 25 (56%) patients died from any cause while 21 (47%) individuals were readmitted for worsening HF. Patients with dSMR versus pSMR according to both EROA and RV showed significantly lower rate of HF readmissions (both p&lt;0.05) (Figure 1, 2). In Cox regression analysis combining clinical and imaging parameters, dSMR was the only independent predictor of HF readmissions (HR 0.20, 95% CI 0.07–0.60, p=0.004). In contrast, mortality was similar between dSMR and pSMR (NS) with age as the only independent predictor (HR 1,10; 95% CI 1,03–1,18, p=0,003).

Conclusions
Minimally invasive MVA is associated with significant reduction of HF readmissions in patients with dSMR versus pSMR while the mortality is similar. This suggests the importance of other parameters, i.e. age and degree of LV remodeling, to guide clinical management in SMR.

Funding Acknowledgement
Type of funding source: None
Reverse remodelling, changes in diastolic function and their prognostic value compared to natriuretic peptides
Authors: Aimo A , Vergaro G , Fabiani I , Chubuchny V , Taddei C , Giannoni A , Arzilli C , Passino C , Emdin M 
Published: November 2020

Abstract

Background
Reverse remodelling (RR) is the recovery from left ventricular (LV) dilation and dysfunction in response to treatment for heart failure (HF). RR is usually associated with improved prognosis. The impact of RR on indices of diastolic function, and the relative prognostic value of RR, changes in diastolic function and natriuretic peptide levels are currently unknown.

Methods
We analysed data from patients with stable systolic HF (LV ejection fraction [LVEF] &lt;50%) undergoing 2 transthoracic echocardiograms (TTE) within 12±2 months. RR was defined as a ≥15% reduction in LV end-systolic volume index (LVESVi). The follow-up started after the second TTE.

Results
927 patients were evaluated (68±12 years; median LVEF 35% [interquartile interval 30–43%]; 27% women; 52% ischaemic aetiology). Patients experiencing RR (n=286, 31%) displayed more prominent positive changes in several parameters reflecting diastolic dysfunction, namely E/e' ratio, left atrial volume index (LAVi), and systolic pulmonary artery pressure (sPAP), as well as N-terminal fraction of pro-B-type natriuretic peptide (NT-proBNP; Figure). In the whole population, percent changes (Δ%) LVESVi displayed weak but significant correlations with Δ% E/e' (r=0.237, p&lt;0.001), LAVi (r=0.316, p&lt;0.001), and sPAP (r=0.158, p&lt;0.001), and also with Δ% NT-proBNP (r=0.279, p&lt;0.001). There were 123 cardiovascular deaths and 4 heart transplantations over 2.8 years (1.3–4.9). Δ% LVESVi, RR, Δ% sPAP and Δ% NT-proBNP were univariate predictors of this endpoint. In 2 multivariable models including Δ% sPAP and Δ% NT-proBNP and either RR or Δ% LVESVi, only Δ% NT-proBNP emerged as independent predictor of outcome (hazard ratio 1.01, 95% confidence interval 1.01–1.02; p&lt;0.001).

Conclusions
A recovery of LV geometry is accompanied by positive modifications in several indices related to diastolic function, as well as a decrease in NT-proBNP levels. Percent changes in NT-proBNP over 12 months are stronger predictors of outcome than variations in LV geometry or sPAP.

Funding Acknowledgement
Type of funding source: None
Usefulness of diastolic dysfunction score in predicting long-term prognosis of acute myocardial infarction patients with preserved ejection fraction
Authors: Bae S.A , Kim K.H , Kim H.Y , Park H.J , Cho J.Y , Yoon H.J , Park J.C 
Published: November 2020

Abstract

Background
To investigate the usefulness of left ventricular diastolic dysfunction (LVDD) score in the prediction of future major cardiovascular events (MACEs) in acute myocardial infarction (AMI) patients with preserved ejection fraction (EF).

Methods
Among 2,539 AMI patients from January 2012 to December 2015, a total of 1,374 patients with preserved EF and no atrial fibrillation were enrolled and were followed up for 3 years. Four parameters which were used for the categorization of DD in the current 2016 recommendation of American Society of Echocardiography (ASE) (septal e' &lt;7cm/s, E/e' &gt;14, tricuspid regurgitation velocity &gt;2.8m/s, and LAD &gt;40mm) were used for DD scoring. The integer score was assigned to each parameter as 1 point. The development of MACEs including death, recurrent MI, any revascularization, or hospitalization due to heart failure (HHF) was evaluated.

Results
Study subjects were divided into 5 groups by the current 2016 ASE criteria; LVDD score 0 (n=354), score 1 (n=496), score 2 (n=333), score 3 (n=139), and score 4 (n=52). During 3 years of clinical follow up, MACEs were developed in 271 patients; 142 death, 74 recurrent MI, 99 revascularization, and 32 HHF. MACEs were significantly increased as LVDD scores were increased; MACEs in LVDD score 0 (n=43, 12.1%), score 1 (n=73, 14.7%), score 2 (n=73, 21.9%), score 3 (n=51, 36.7%), and score 4 (n=31, 59.6%), (ptrend &lt;0.001). On Kaplan-Meier survival curve analysis, MACEs free survival was significantly lower as LVDD scores were increased (Figure 1).

Conclusion
The present study demonstrated that MACEs were significantly increased as LVDD scores were increased in AMI patients with preserved EF. Therefore, it is suggested that this novel scoring system by using the current 2016 ASE criteria for diastolic function evaluation may provide comprehensive risk assessment and thus would be useful in predicting upcoming CV events in AMI patients with preserved EF.
MACE free survival according to the LVDD

Funding Acknowledgement
Type of funding source: None
Is it important to maintain the reverse remodeling?
Authors: Furquim S.R , Ferreira J.C.L.A , Mario A.D.S , Biselli B , Gomes B.R , Chizzola P.R , Salemi V.M.C , Munhoz R.T , Bocchi E.A , Ayub-Ferreira S.M 
Published: November 2020

Abstract

Background
Consistent advances in Heart Failure (HF) treatment have generated a new phenotype: reverse remodelling (RR). These patients have better outcomes than those who don't achieve the RR, however little is known about the long-term remodelling maintenance and its predictors or about a new worsening on ejection fraction (EF).

Purpose
To analyze the difference between patients who maintain the RR, those who can not maintain it and those who have not improved.

Methods
Observational study that analyzed features in outpatients with HF and initial EF lower than 40%, an intermediary EF, and last EF in 2014, 2015 and 2016, with a minimal interval of 6 months. Patients were divided into 3 groups: Negative RR (NRR - All EF &lt;40%); non-maintained RR (NMRR – 2nd EF &gt;40% and 3rd EF&lt;40%) and Maintained RR (MRR – 2nd and 3rd EF &gt;40%). Comparisons were made by Kruskal-Wallis test and the survival was analyzed by Kaplan Meyer and Log-Rank tests.

Results
1762 medical records were analyzed and 1484 were included. 993 patients had NRR, 201 patients had NMRR and 290 patients had MRR. The initial EF was lower in the NRR group. In the first 3 years, the groups NMRR and MRR improve the EF by 16.4% (±1.2) and 18.1% (±1.1), respectively. During the next 3 years, the NMRR group lost this improvement (−16.1% ±1.1), while the MRR group maintained it (0.7% ±1.4). The MRR group had more hypertension (0.75±0.05) as comorbidity, while the NMRR had more myocardial infarction (0.39±0.07) and myocardial revascularization (0.17±0.05). Chagasic and alcoholic aetiologies predominated in the NRR group (0.05±0.01 and 0.19±0.02) and these patients had less valvar cause (0.04±0.01). The NMRR group had more ischemic aetiology (0.41±0.07), and the MRR had more hypertensive (0.22±0.05). General survival was different between the three groups (p&lt;0.001) major in MRR, NMRR and NRR group, respectively. Survival after the last EF also was significantly different between the groups (p&lt;0.001) with the same pattern.

Conclusion
Achieving RR is important, but maintaining it can bring better outcomes and prognosis. Therefore, it is important to identify factors and therapeutic goals for the RR maintenance.
Figure 1

Funding Acknowledgement
Type of funding source: None
Dapagliflozin improves left ventricular myocardial longitudinal function in people with type 2 diabetes
Authors: Brown A.J.M , Gandy S , McCrimmon R , Struthers A , Lang C 
Published: November 2020

Abstract

Background/Introduction
Asymptomatic left ventricular (LV) dysfunction is highly prevalent in patients with type 2 diabetes mellitus (T2DM). Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been shown to reduce all-cause mortality and hospitalisations for heart failure in patients with T2DM. The underlying mechanisms for these cardiovascular benefits are unclear. In the Dapa-LVH trial, we had previously shown that dapagliflozin treatment significantly reduces LV mass (LVM) compared to placebo in patients with T2DM and LV hypertrophy (LVH).

Purpose
The objective of this sub-study of the Dapa-LVH study was to assess whether dapagliflozin treatment improves LV myocardial longitudinal function and LV diastolic function in patients with T2DM and LVH.

Methods
We randomly assigned 66 people (mean age 67±7 years, 38 males) with T2D, LVH with a normal LV ejection fraction to receive dapagliflozin 10mg once-daily or placebo for 12 months. The primary endpoints were change in global longitudinal strain (GLS) and LV diastolic function defined as the ratio of mitral inflow E to mitral e' annual velocities assessed using echocardiography. Secondary endpoints were left ventricular and atrial volumes assessed using cardiac magnetic resonance.

Results
Dapagliflozin treatment resulted in a median increase in GLS of −1.64±2.5% vs placebo −0.2±1.8; p=0.024, with a mean difference of −1.4% (95% CI: −2.7 to −0.2). There was a trend towards a reduction left atrial area with a median change in left atrial area of the dapagliflozin group −0.5±3.75 cm2 vs placebo group 0.0±3.5 cm2; p=0.088), leading to an absolute mean difference of −1.29cm2 (95% CI: −3.01 to 0.44). There was no significant difference between dapagliflozin and placebo in E/e' and in LV volumes.

Conclusion
Dapagliflozin treatment improved LV myocardial longitudinal function which may suggests it may improve subclinical LV dysfunction.

Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): This study was funded by an Externally Sponsored Research grant from Astra Zeneca – (grant number ESR-14-10168
Pulmonary vein isolation for atrial fibrillation patients with reduced left ventricular ejection fraction
Authors: Ikenouchi T , Inaba O , Kono T , Murata K , Takamiya T , Inamura Y , Sato A , Nitta J , Takahashi Y , Goya M , Sasano T 
Published: November 2020

Abstract

Background/Introduction Pulmonary vein isolation (PVI) is a cornerstone of curable treatment for atrial fibrillation (AF). Left ventricular (LV) ejection fraction (EF) occasionally improves after PVI in AF patients with reduced LVEF (rEF), the mechanism of which is not fully understood. CASTLE-AF trial have demonstrated that PVI with radiofrequency (RF) catheter for AF patients with rEF can reduce their mortality and heart failure. Nevertheless there are limited data about the clinical outcome of the PVI for patients with impaired LV function.

Purpose
This study was to evaluate the efficacy of PVI and improvement of LVEF after the procedure in AF patients with rEF.

Methods
A total of 2709 consecutive AF patients (age 65±39 y/o, male 67%) underwent their first PVI with cryoballoon or RF catheter in our facility from April 2014 to March 2019, and retrospectively analyzed. All the patients underwent echocardiogram before and half to one year after the procedure. Patients with LVEF under 40% before the PVI were selected (n=111) and divided into two groups based on whether there were specific etiologies of LV function impairment (group A) or not (group B).

Results
There were no significant difference in mean LVEF between group A (n=40) and group B (n=71) (32±6% vs 33±6%, p=0.12). The major etiology of rEF in group A were old myocardial infarction (n=20, 18%), hypertensive heart disease (n=6, 5.4%), and dilated cardiomyopathy (n=5, 4.5%). After mean follow-up of 2.7 years, there were no significant difference in clinical outcome after the procedure between two groups (1-year Kaplan–Meier event rate estimates; 72.2% vs 72.9%; p=0.85). The change amounts of LVEF after the PVI were significantly higher in group B (20±14%) compared to group A (2±10%) (p&lt;0.001). Multivariable Cox regression analysis revealed that age was the independent significant predictors of EF improvement over 10% in group B (p=0.048).

Conclusions
In AF patients with reduced LVEF, there were no significant difference in efficacy of PVI between those who have specific etiologies of LV function impairment other than AF and who have not. The improvement of LVEF after PVI was significantly larger in patients without specific etiologies compared to those with.

Funding Acknowledgement
Type of funding source: None