bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular dysfunction by 3D echocardiography is the best predictor for death and re-hospitalization in patients with heart failure with reduced ejection fraction
Authors: Mihaila S , Velcea A , Andronic A , Rimbas R.C , Chitroceanu A , Calin S.I , Vinereanu D 
Published: November 2020

Abstract

Background
In patients with heart failure with reduced ejection fraction (HFrEF), right ventricular (RV) size and dysfunction by 2-dimensional echocardiography (2DE) were identified as risk factors for mortality and morbidity, but 3-dimensional echocardiography (3DE) enabled itself as a more reproducible and accurate method.

Aim
To assess the comparative prognostic value of parameters of RV size and dysfunction, measured by 2DE and 3DE, in patients with ischemic and non-ischemic HFrEF, on optimal clinical care, at long-term follow-up.

Methods
142 consecutive patients (62±12 yrs, 104 males) with HFrEF, in sinus rhythm, were assessed by 2DE and 3DE, including RV full-volume acquisitions. RV diameter (RVd), RV end-systolic (RV_EDA) and end-diastolic areas (RV_ESA), RV fractional area change (RVFAC), and 2D_TAPSE were measured by 2DE. RV end-diastolic (RV_EDV) and end-systolic volumes (RV_ESV), RV ejection fraction (RV_EF), and 3D_TAPSE were measured by a dedicated 3DE software. Patients were followed for 37±16 months after the index event. Primary outcome was cardiac death (CD). Secondary outcomes were: 1) HF hospitalizations (HFH); 2) a composite cardiac events (CE) end-point of CD or HFH, myocardial infarction, coronary revascularization, arrhythmias, or CRT.

Results
38 CD, 47 HFH, and 62 CE occurred during follow-up. Mean RVd was 34±7 mm, RV_EDA 20±11 cm2, RV_ESA 12±5 cm2, RV_FAC 37±13%, RV_EDV 84±25 ml/m2, RV_ESV 52±22 ml/m2, and RV_EF 39±10%. Mean 2D_TAPSE was 18±4 mm, while mean 3D_TAPSE was 16±4 mm. By 2DE, only RV_ESA and RV_FAC, but not RV_EDA or RVd, correlated with CD, HFH, and CE. 2D_TAPSE correlated with HFH, but not with CD or CE, while 3D_TAPSE correlated with all primary and secondary outcomes. By 3DE, RV_ESV, but not RV_EDV, correlated with CD, HFH, and CE. Moreover, 3D RV_EF had better correlations with primary and secondary outcomes than 2D RV_FAC (z=3.8, z=2.5, and z=2.5, all p&lt;0.01). By multivariate linear regression analysis including RV_ESA, RV_FAC, RV_ESV, RV_EF, and 3D_TAPSE, only RV_EF was an independent predictor for CD and HFH (r2=0.68 and r2=0.30, both p&lt;0.001).

Conclusion
In patients with ischemic and non-ischemic HFrEF, 3DE parameters of RV size and dysfunction are better predictors for death and re-hospitalization than 2DE parameters. The RV_EF measured by 3DE was the best predictor for death in patients with HFrEF.

Funding Acknowledgement
Type of funding source: None
Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction
Authors: Vratonjic J , Milasinovic D , Asanin M , Vukcevic V , Zaharijev S , Pavlovic A , Jelic D , Radomirovic M , Zobenica V , Mehmedbegovic Z , Stankovic G 
Published: November 2020

Abstract

Background
Previous studies associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI).

Purpose
Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI).

Methods
This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (&gt;50%).

Results
mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF&lt;40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF&lt;40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p&lt;0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p&lt;0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p&lt;0.001) and median age (61 vs. 59 vs. 64 years, p&lt;0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p&lt;0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p&lt;0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p&lt;0.001).

Conclusion
Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (&lt;40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality.

Funding Acknowledgement
Type of funding source: None
Liver stiffness as measured by transient elastography is an independent predictor of outcomes in patients with chronic heart failure
Authors: Avila D.X , Villacorta H.V , Cabrita C.M.L , Santos R.B.G , Ribeiro M.L , Gismondi R.A , Mocarzel L.O , Guarana T 
Published: November 2020

Abstract

Background
Patients with chronic heart failure (HF) may have liver abnormalities due to systemic congestion. Transient elastography (TE) has been used to assess liver stiffness (LS) in patients with primary liver disease. Some studies have suggested that congestion can influence liver stiffness.

Purposes
We sought to assess the role of LS in the prediction of outcomes in patients with chronic HF.

Methods
Nine-three consecutive patients with chronic HF were screened and fulfilled the inclusion criteria which consisted of signs or symptoms of HF and left ventricle ejection fraction (LVEF) less than 50%. Patients with concomitant liver disease were excluded or techical problems during TE. Patients underwent routine laboratory tests, liver function tests and TE. The primary endpoint was time to first event, which was defined as a composite of cardiovascular death or HF hospitalization.

Results
Mean follow up was 219±86 days. Nine patients were excluded due to exclusion criteria or technical problems during the TE. Eighty-four patients were included in the final analysis. Mean age was 63.2±12.2 and 57 (67.8%) were male. Mean ejection fraction and median NT-proBNP were, respectively, 38.7±14.3% and 1,140 pg/mL (interquartile range 224.3–2,810.3). Median LS for the entire population was 5.35 (3.7–10.65) kPa. LS correlated with NT-proBNP (r=0.54; p&lt;0.0001), total bilirubin (r=0.47; p&lt;0.001), direct bilirubin (r=0.66; p&lt;0.0001), alkaline phosphatase (r=0.57; p&lt;0.0001); γ-glutamyl-transpeptidase (r=0.59; p&lt;0.0001), and age (r=−0.22; p=0.03). A Receiver Operating Characteristic (ROC) curve was performed and a cut point of 5.9 kPa showed sensitivity of 80% and specificity of 64.1% with area under the curve of 0.73. Mean event-free survival time for patients above and below this cutoff was 215.2±20 vs 302.8±7.2 days (p=0.0001; log rank test). Using Cox proportional hazard model (independent variables: LS as a continuous variable, age, gender, NT-proBNP, LVEF, and creatinine), only LS was independently associated with the primary endpoint (hazard ratio 1.05, 95% confidence interval 1.01–1.09; for each increment of one unit of LS).

Conclusion
LS correlates with biomarkers of myocardial stretch and several liver function tests and is an independent predictor of outcomes in patients with chronic HF.

Funding Acknowledgement
Type of funding source: Public hospital(s). Main funding source(s): Own funding and examinations carried out with a welfare fund.
Trends in cause-specific readmissions in heart failure with preserved versus reduced and mid-range ejection fraction
Authors: Cui X.T , Thunstrom E , Dahlstrom U , Zhou J.M , Ge J.B , Fu M 
Published: November 2020

Abstract

Background
It remains unclear whether the readmission of heart failure (HF) patients has decreased over time and how it differs among HF with preserved ejection fraction (EF) (HFpEF) versus reduced EF (HFrEF) and mid-range EF (HFmrEF).

Methods
We evaluated HF patients index hospitalized from January 2004 to December 2011 in the Swedish Heart Failure Registry with 1-year follow-up. Outcome measures were the first occurring all-cause, cardiovascular (CV) and HF readmissions.

Results
Totally 20,877 HF patients (11,064 HFrEF, 4,215 HFmrEF, 5,562 HFpEF) were included in the study. All-cause readmission was highest in patients with HFpEF, whereas CV and HF readmissions were highest in HFrEF. From 2004 to 2011, HF readmission rates within 6 months (from 22.3% to 17.3%, P=0.003) and 1 year (from 27.7% to 23.4%, P=0.019) in HFpEF declined, and the risk for 1-year HF readmission in HFpEF was reduced by 7% after adjusting for age and sex (P=0.022). Likewise, risk factors for HF readmission in HFpEF changed. However, no significant changes in cause-specific readmissions were observed in HFrEF. Time to the first readmission did not change significantly from 2004 to 2011, regardless of EF subgroup (all P-values&gt;0.05).

Conclusions
Although the burden of all-cause readmission remained highest in HFpEF versus HFrEF and HFmrEF, a declining temporal trend in 6-month and 1-year HF readmission rates was found in patients with HFpEF, suggesting that non-HF-related readmission represents a big challenge for clinical practice.

Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The SwedeHF was funded by the Swedish National Board of Health and Welfare, the Swedish Association of Local Authorities and Regions.
Geographic variation in the outcome of patients hospitalized for heart failure: analysis of a nationwide inpatient database
Authors: Yotsumoto H , Kaneko H , Itoh H , Kiriyama H , Kamon T , Fujiu K , Morita K , Michihata N , Jo T , Morita H , Yasunaga H , Komuro I 
Published: November 2020

Abstract

Background
The prevalence of heart failure (HF) is increasing in developed countries. Considering the significant socioeconomic burden of HF, nationwide actions against HF are indispensable. To that end, relevant information on regional variations among HF patients are required.

Purpose
We aimed to explore the geographic variations in the characteristics and outcomes of hospitalized HF patients using a nationwide inpatient database.

Methods and results
Using the Diagnosis Procedure Combination database which is a nationwide inpatient database in Japan, we carried out a comprehensive analysis of 447,818 hospitalized patients with HF (median age 81 years, 238,192 men) who were admitted between January 2010 and March 2018 in Japan. We divided the study population into seven geographical regions based on the location of the admitted hospital. Background characteristics were almost similar among all seven regions. The implementation rates of intubation, hemodialysis, inotropic agent, and advanced circulatory supports including intra-aortic balloon pumping and extracorporeal membrane oxygenation varied among the seven regions. There was a significant difference in the length of hospital stay and the in-hospital mortality among the seven regions. The multivariable logistic regression analysis including baseline clinical charasteristics and medication administered within two days after hospital admission fitted with a generalized estimation equation for in-hospital mortality showed that there was still a significant difference in the in-hospital mortality among the seven regions (Table).

Conclusion
The analysis of a nationwide inpatient database showed that geographical variations existed regarding the outcomes of patients hospitalized for HF. This suggests the necessity of further efforts to establish a standardized medical care system in this era of HF pandemic.

Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Grants from the Ministry of Health, Labour and Welfare, Japan (19AA2007 and H30-Policy-Designated-004) and the Ministry of Education, Culture, Sports, Science and Technology, Japan (17H04141)
Inverse association of mortality and BMI in patients with cardiomyopathy of any etiology
Authors: Brazile T , Mulukutla S , Thoma F , Saba S 
Published: November 2020

Abstract

Background
Obesity is a worldwide epidemic that has been associated with poor outcomes. Previous studies have demonstrated an inverse relationship between body mass index (BMI) and patients' outcomes, the “obesity paradox”, in several diseases.

Purpose
We sought to evaluate whether the obesity paradox applies to cardiomyopathy patients of all etiologies, using all-cause mortality as the primary endpoint.

Methods
We conducted a retrospective study of cardiomyopathy patients (n=18,003) seen within the UPMC network between January 2011 and December 2017. Patients were divided into 4 BMI categories (underweight, normal weight, overweight, and obese) and stratified by left ventricular ejection fraction (LVEF): &lt;20%, 20–35%, and 36–50%. A Cox proportional hazards model was created to assess the independent predictive value of BMI on mortality.

Results
Over a median follow-up of 2.28 years, higher BMI was associated with better survival for the overall cohort (Figure) and within LVEF strata (p&lt;0.0001). The most common cause of hospitalization was subendocardial infarction among underweight and normal weight patients and heart failure among overweight and obese patients. Cox proportional hazards model showed that BMI, age, and comorbid conditions of COPD, CKD, and CAD are independent predictors of death.

Conclusion
Our results support the existence of an obesity paradox impacting all-cause mortality in cardiomyopathy patients of all etiologies even after adjusting for LVEF. Additional research is needed to understand the effect of weight loss on survival once a diagnosis of cardiomyopathy is established.
Figure 1. Kaplan-Meier Survival Estimates

Funding Acknowledgement
Type of funding source: None
A real-world assessment of the burden associated with hospitalizations in US patients with heart failure and left ventricular ejection fraction (LVEF) greater than 40%
Authors: Lahoz R , Studer R , Farries G , Proudfoot C , Suminska S , Watkin A , Fagan A , Corda S , Houchen E , Mather P.J 
Published: November 2020

Abstract

Background and purpose
Heart failure (HF) is one of the leading causes of hospitalization among older adults and is associated with a large burden of disease for the individual, the patient's family, healthcare systems, and society. This study assessed the burden of hospitalizations in patients with HF with LVEF &gt;40% in the United States (US).

Methods
This retrospective, non-interventional study identified adult patients with incident or prevalent HF in Optum® de-identified Electronic Health Record (EHR) dataset (2007–2018) between 01/01/2013 and 31/12/2017. Optum's longitudinal EHR repository is derived from dozens of healthcare provider organizations in the US, that include more than 700 Hospitals and 7000 Clinics; treating &gt;95 million patients receiving care in the US. Patients were followed for up to 1 year or until last active date whichever occurred first. Comorbidities, all-cause hospitalizations (AcH) and primary cause HF hospitalizations (HFH) were analysed.

Results
120,606 patients with HF and LVEF &gt;40% (54% female) with a mean (SD) age of 71 (13) yrs were included, representing 80,324.74 patient-yrs follow-up (days). Common comorbidities were hypertension (91.8%), ischemic heart disease (IHD, 71.4%), atrial fibrillation (AF, 54.8%), renal disease (54.1%), type 2 diabetes (T2D, 50.7%), obesity (44.6%) and anemia (39%). Comorbidities including IHD (72.9% vs. 68.4%), AF (56.4% vs. 51.6%) and T2D (51.1% vs. 49.9%) were more often recorded in patients with LVEF &gt;40-≤60% than &gt;60% cohort while hypertension (91.6% vs. 92.2%), renal disease (53.8% vs. 54.6%), obesity (43.9% vs. 46.1%) and anemia (38.1% vs. 40.9%) had significantly higher frequency in the LVEF &gt;60% cohort. The annualized AcH rate for patients with LVEF&gt;40% was 1.44 and annualized HFH rate was 0.24 with a median length of stay of 3 and 4 days, respectively. Annualized hospitalization rates were significantly higher for women than men (both AcH and HFH). AcH rates were significantly higher and HFH rates were significantly lower for patients with LVEF&gt;60% compared with LVEF &gt;40-≤60.

Conclusions
This study demonstrates that patients with HF and LVEF &gt;40% experience significant burden from comorbidities and hospitalizations from any-cause and for HF. The hospitalization rates are higher in women (both AcH and HFH) or patients with LVEF &gt;60% (AcH only). Further focus on reduction of hospitalizations and interdisciplinary management of patients with HF should be warranted.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Concordance between patient and physician reported symptoms in patients with heart failure and a LVEF equal to or less than 60%: a multinational survey in the EU
Authors: Fonseca A.F , Corda S , Lahoz R , Proudfoot C , Jackson J , Cotton S , Studer R 
Published: November 2020

Abstract

Background and purpose
Heart Failure (HF) is associated with symptoms such as dyspnoea and fatigue, however, physicians and patients' perception of HF symptoms may differ. This study aimed to explore the extent to which symptoms experienced by patients with HF are recognized by their physician and if physicians over- or under-reported HF symptoms.

Methods
A cross-sectional study of patients with HF was conducted in France, Germany, Italy, Spain and the United Kingdom (Disease Specific Programme in HF by Adelphi Real World). Patient record forms (PRFs) were completed by 257 cardiologists and 158 general practitioners (GPs) for consecutively consulting patients. The same patients were invited to complete a patient self-completion questionnaire (PSC). Only responses from PRFs with an associated PSC were analysed. Concordance was calculated as agreement between PSC and PRF when both were aligned with the presence or absence of HF symptom out of the total number of matched pairs. The over- or under-reporting of the occurrence of symptoms by the physicians relative to patient-reported symptoms was also calculated by taking the patient perspective and evaluating how often a patient-reported symptom was not recognized in the PRF (physician under-reporting) and vice versa (physician over-reporting).

Results
792 HF patients with LVEF ≤60% (35% female) with a mean age of 68.6 years were included. 58% of PRFs were completed by cardiologists and 42% by GPs. The most common patient reported HF symptoms were dyspnoea when active (74%), fatigue (59%) and oedema (42%) (Figure 1a).
Overall, a high concordance rate was observed in reporting of HF symptoms between patients and their physicians ranging between 75% for fatigue and 94% for gastric/intestinal discomfort (Figure 1b). In non-concordant cases, most symptoms were under-reported by physicians, except dyspnoea when active and fatigue/weakness which were over-reported in 34/33%, respectively. The frequency of over-reporting of HF symptoms by the physicians was higher for more frequently patient reported symptoms while under-reporting was observed in less frequently reported symptoms such as gastric/intestinal discomfort, swelling of abdomen, inability to sleep, paroxysmal nocturnal dyspnoea and orthopnoea (Figure 1c).

Conclusions
The current study suggests that there is an overall high concordance between physicians and patients in reporting HF symptoms. However, while physicians were aware of the most prevalent HF symptoms experienced by patients, it was more common to under-report the less frequent HF symptoms. Ensuring patient education and good communication between patients and their physicians might help better and earlier identification of HF symptoms.

Funding Acknowledgement
Type of funding source: Private company. Main funding source(s): Novartis Pharma AG
Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes
Authors: Stepien K , Furczynska P , Zalewska M , Nowak K , Wlodarczyk A , Owsianka I , Skorek P , Zalewski J , Nessler J 
Published: November 2020

Abstract

Background
Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown.

Purpose
We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes.

Methods
142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected.

Results
SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007).

Conclusions
As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization.
The survival free of rehospitalization

Funding Acknowledgement
Type of funding source: None