bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic effect of the electrocardiographic pattern following cardiac resincronization
Authors: Asensio Nogueira J , Salgado-Aranda R , Garcia-Fernandez F.J , Martin-Gonzalez F.J , Villagraz-Tecedor L , Alvarez-Calderon M , Gomez-Llorente M , Sanchez-Corral E , Fernandez-Gonzalez B , Perez-Rivera J.A 
Published: October 2021

Abstract

Introduction
Following cardiac resincronization therapy (CRT), QRS duration is the most important prognostic factor in the 12-lead electrocardiogram (ECG). However, there is little evidence regarding if the electrocardiographic pattern following CRT has impact on morbidity and mortality.

Purpose
In this historical cohort study we analysed if a certain pattern in three leads of the ECG (Rs in V1, Qr in aVL or rS in I) is associated with lower incidence of adverse outcomes in a population of CRT patients within 1 year of implant. Other variables previously associated with success or failure of CRT were analysed.

Methods
Patients with CRT devices (pacemaker or defibrillator) with left ventricle lead in the coronary sinus were included from January 2012 to April 2019. One year clinical follow-up was performed. The primary endpoint was a composite of death of any cause and heart failure hospitalization. Differences in categorical data were reported as frequencies then compared using χ2 tests. Continuous variables were reported as means ± standard deviation with differences between groups tested using independent samples t-tests. Survival analysis was performed using Kaplan-Meier test, comparing survival graphics through Log-Rank test. For multivariate analysis, Cox regression was performed. Variables that showed significance in the univariate analysis were included.

Results
111 patients were included. Sample was divided into 2 groups according to the presence of the pattern in any of the three ECG leads. Two patients (1.8%) presented Rs in V1 and Qr in aVL simultanously and two patients (1.8%) presented Rs in V1 and rS in I. None of the patients presented all three patterns simultaneously. Baseline characteristics are reported in Table 1. Presence of any of the three patterns was independently associated with a lower incidence of the primary endpoint (2.3% vs. 17.6%, hazard ratio 0.1, 95% confidence interval 0.013–0.774, p=0.016). Previous atrial fibrillation was also independently associated with a higher incidence of the primary endpoint. QRS duration postimplantation did not showed prognostic value.

Conclusion
The presence of the patterns Rs in V1, Qr in aVL or rS in I is an independent predictor of good prognosis in patients with CRT.

Funding Acknowledgement
Type of funding sources: None. Baseline characteristicsKaplan Meier survival curves
Empagliflozin reduces TNFa-induced reactive oxygen species through inhibition of the human endothelial Na+/H+ exchanger 1
Authors: Uthman L , Baumgart P , Baartscheer A , Schumacher C.A , Li X , Hermanides J , Preckel B , Hollmann M.W , Coronel R.C , Zuurbier C.J , Weber N.C 
Published: October 2021

Abstract

Background
Chronic low-grade inflammation, endothelial dysfunction and oxidative stress are major interactive pathways contributing to the pathogenesis of HFpEF. The sodium/glucose cotransporter 2 (SGLT2) inhibitor Empagliflozin (EMPA) inhibits inflammation-induced ROS generation in endothelial cells. EMPA also lowers Na+/H+ exchanger 1 (NHE1) activity and cytoplasmatic Na+ levels ([Na+]c) in cardiomyocytes.

Purpose
It is unknown how inflammation causes oxidative stress in endothelial cells and how EMPA can mitigate this. Here we examined for human endothelial cells whether 1) inflammatory mediators activate NHE1 activity, 2) increased [Na+]c mediates the inflammation-induced ROS production, and 3) EMPA reduces inflammation-induced ROS through NHE1 inhibition.

Methods
Human umbilical vein endothelial cells (HUVECs) and human coronary artery endothelial cells (HCAECs) were incubated with vehicle (V), 10ng/mL TNFα, 1μM EMPA or the canonical NHE1 inhibitor 10μM Cariporide. NHE1 activity was measured using the intracellular pH sensitive seminaphtharhodafluor fluorescence, by the pH recovery rate after an ammonium pulse. Intracellular ROS were detected by fluorescent live cell imaging in the presence of 10ng/mL TNFα or under increased Na+ conditions using 100nM ouabain (partial inhibition of the Na+/K+ pump). [Na+]c was measured using the sodium-binding benzofuran isophthalate 1 fluorescent probe.

Results
TNFα enhanced NHE1 activity in HCAECs (Fig a, in Δ[H+]/sec, V 0.81±0.14, TNFα 1.86±0.35 p&lt;0.05). Increasing [Na+]c by ouabain elevated ROS generation (Fig b, in mM, HUVECs; V 5.6±1.3, ouabain 25.2±1.6 p&lt;0.001, HCAECs; V 18.5±2.4, ouabain 91.2±32.6 p&lt;0.05). EMPA reduced NHE1 activity in HUVECs (in Δ[H+]/sec, V 3.55±0.54, EMPA 1.66±0.25 p&lt;0.01 vs V, Cariporide 0.95±0.11 p&lt;0.001 vs V). HCAECs showed similar results. EMPA lowered [Na+]c (HUVECs; from 8.8±0.9 to 6.0±0.5 mM, p&lt;0.05, HCAECs; from 7.8±0.7 to 4.0±0.8 mM, p&lt;0.001). ROS generation was reversed in the presence of EMPA and/or Cariporide indicating that the effect was mediated by NHE inhibition (Fig c).

Conclusions
TNFα induces oxidative stress in EC through NHE1 activation and the consequently increased [Na+]c. EMPA acutely inhibits TNFα-induced ROS generation by inhibiting NHE1 and lowering [Na+]c in human cardiac and non-cardiac endothelial cells. Our data suggest that the previously reported cardiac effects of EMPA on NHE1 and [Na+]c are also present in endothelial cells. Endothelial ion homeostasis may be a valuable target to reduce inflammation-induced ROS generation and can constitute the pathway through which SGLT2 inhibitors offer protection in HFpEF patients, as examined in the EMPEROR-Preserved trial.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Prevalence of heart failure with preserved ejection fraction in antiphospholipid antibodies syndrome. The multicenter ATHERO-APS study
Authors: Pastori D , Ames P.R , Triggiani M , Cammisotto V , Carnevale R , Pignatelli P , Bucci T 
Published: October 2021

Abstract

Background
The prevalence of heart failure with preserved ejection fraction (HFpEF) in patients with antiphospholipid syndrome (APS) is unknown.

Methods
Prospective multicenter cohort study including 125 patients: 91 primary APS (PAPS), 18 APS-SLE, and 16 carriers. HFpEF was diagnosed according to the 2019 European Society of Cardiology criteria: patients with ≥5 points among major and minor functional and morphological criteria including NT-ProBNP &gt;220 pg/ml, left atrial (LA) enlargement, increased left ventricular filling pressure.

Results
Overall, 18 (14.4%) patients were diagnosed with HFpEF; this prevalence increased from 6.3% in carriers to 13.2% in PAPS and 27.8% in APS-SLE (Figure). Patients with HFpEF were older and with a higher prevalence of hypertension and previous arterial events. At logistic regression analysis, age, arterial hypertension, anticardiolipin antibodies IgG &gt;40 GPL (odds ratio [OR] 3.43, 95% Confidence Interval [CI] 1.09–10.77, p=0.035), anti β-2-glycoprotein-I IgG &gt;40 GPL (OR 5.28, 1.53–18.27, p=0.009), lupus anticoagulants DRVVT &gt;1.25 (OR 5.20, 95% CI 1.10–24.68, p=0.038), (OR 3.56, 95% CI 1.11–11.47, p=0.033) and triple positivity (OR 3.56, 95% CI 1.11–11.47, p=0.033) were associated with HFpEF after adjustment for age and sex.

Discussion
HFpEF has a clinically relevant prevalence in patients with APS. The role of antiphospholipid antibodies in the pathogenesis and prognosis of HFpEF needs to be investigated.

Funding Acknowledgement
Type of funding sources: None.
Clinical significance of spleen size in patients with heart failure
Authors: Hiraiwa H , Okumura T , Sawamura A , Kondo T , Araki T , Mizutani T , Kazama S , Kimura Y , Shibata N , Oishi H , Kuwayama T , Furusawa K , Morimoto R , Murohara T 
Published: October 2021

Abstract

Background
The spleen is an important organ that stores blood, releases erythrocytes or monocytes, and destroys no-longer-needed platelets. It can reserve 20–30% of the total blood volume, and its size is reduced in hypovolemic shock. However, the clinical significance of the spleen size in patients with heart failure (HF) remains unclear.

Purpose
The purpose of this study was to investigate the relationship between spleen size, hemodynamic parameters, and prognosis in patients with HF.

Methods
A total of 219 patients with clinically stable HF were enrolled. All patients underwent right heart catheterisation and computed tomography. The spleen size was measured using computed tomography volumetry. In addition, spleen volume was assessed using the spleen volume index (SVI), corrected for body surface area. Cardiac events were composite endpoints of cardiac death, hospitalisation for worsening HF, fatal arrhythmias, implantation of cardiac devices, implantation of left ventricular assist devices, and unexpected percutaneous coronary intervention or cardiac surgery. Spearman's rank correlation coefficient was used to examine the relationship between spleen volume and hemodynamic parameters. Multivariate Cox hazard regression models were used to investigate whether SVI was an independent determinant of cardiac events.

Results
Of the 219 patients (median age, 54 [interquartile range] 46–64 years), 145 (66%) were males. The median (interquartile range) spleen volume and SVI was 118.0 (91.5–156.0) mL and 67.8 (54.9–87.2) mL/m2, respectively. SVI was positively correlated with cardiac output (r=0.269, P&lt;0.001), and negatively correlated with systemic vascular resistance (r=−0.302, P&lt;0.001) (Figure 1). A total of 70 cardiac events were observed, and the optimal cut-off value of SVI for cardiac events was 68.9 mL/m2 in the receiver operating characteristic analysis. Patients were divided into two groups: low-SVI (n=107, &lt;68.9 mL/m2) and high-SVI groups (n=112, ≥68.9 mL/m2). Blood adrenaline concentration was higher in the low-SVI group than in the high-SVI group (0.039 [0.020–0.057] ng/mL vs 0.026 [0.014–0.044] ng/mL, P=0.004). The low-SVI group had more cardiac events than the high-SVI group (log-rank test, P&lt;0.001) (Figure 2). In the multivariate Cox proportional hazard model, the low-SVI group was an independent predictor of cardiac events, even when adjusted for the conventional validated HF risk score, blood catecholamine levels, and hemodynamic parameters.

Conclusion
The spleen size may affect the prognosis in patients with HF, reflecting haemodynamics, including systemic circulating blood volume status and sympathetic nerve activity.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Features of chronic heart failure in COVID-19 pandemic
Authors: Grigoricheva E , Gessen G.R 
Published: October 2021

Abstract

Relevance
Current and past coronavirus infection can provoke and aggravate the course of previous chronic heart failure by initiating the processes of thrombus formation, inflammation and fibrinogen synthesis, affecting the pleuropericardial space, increasing the load on the right heart due to pulmonary hypertension.

Purpose of the study
To identify the features of chronic heart failure after COVID-19 infection with lung damage.

Material
An open cohort prospective study of 50 patients was carried out. Inclusion criteria: the presence of a positive brain natriuretic peptide and echocardiographic changes corresponding to systolic or diastolic dysfunction before the onset of the pandemic, signed informed consent. The diagnosis of COVID - 19 was confirmed by a positive PCR test and the presence of M and G antibodies, lung damage - by the results of computed tomography of the lungs.

Methods
Standard clinical examination, quality of life questionnaire, echocardiography with measurement of cavity volume, indicators of left ventricular systolic and diastolic function, size and function of the right ventricle. The second examination was carried out one month after hospitalization.

Results
The features of the clinical picture were an increase in shortness of breath (38 people, 86%), a decrease in exercise tolerance (40 people, 90%), an increase in chest pain (25 people, 60%), palpitations (40 people, 90%). On echocardiography, the most frequent dynamics compared to the 2019 echocardiography indicators were an increase in pressure in the pulmonary artery (44 people, 100%), the size of the right (38 people, 86%) and left ventricles (30 people, 68%), left atrium (38 people, 86%), an increase in the severity of valvular regurgitation (44 people, 100%) and a decrease in the ejection fraction within the “gray zone” (38 people, 86%). The newly emerging decrease in EF below 45% was recorded much less frequently, in 13 people (30%). In 40 (80%) patients, certain signs of deterioration of left ventricular diastolic function were revealed: dilatation of the left atrium, decrease in the mean e, increase in E/e' according to tissue Doppler ultrasonography. The TAPSE index, which characterizes the global function of the right ventricle, practically did not decrease. Frequent findings during echocardiography one month after the disease were a small amount of fluid in the pericardial cavity (30 people, 68%) and pleuropericardial adhesions.

Conclusion
The clinical condition of patients with CHF in the first month after a previous infection with COVID-19 with lung involvement corresponded to a worsening of CHF with rhythm disturbances and instability of blood pressure, which on echocardiographic examination was manifested by dilatation of the heart cavities, valvular regurgitation, diastolic dysfunction of the left ventricle and increased pressure in the arteries.

Funding Acknowledgement
Type of funding sources: None. Dynamics of echocardiography in patients
Predictive value of NT-proBNP in non-obstructive hypertrophic cardiomyopathy
Authors: Hutt E.H , Mentias A.M , Alashi A.A , Fava A.F , Popovic Z.P , Thamilarasan M.T , Lever H.L , Desai M.Y.D 
Published: October 2021

Abstract

Background
We studied the prognostic value of serum NT-proBNP in nonobstructive hypertrophic cardiomyopathy (nHCM) patients.

Methods
We studied 777 nHCM patients (55±13 years, 54% men, maximal left ventricular outflow tract gradient [LVOTG] &lt;30 mm Hg) with serum NT-proBNP measured at baseline. We excluded patients with prior septal myectomy (SM) & LV ejection fraction (LVEF) &lt;55%. NT-proBNP was adjusted for age & sex & converted to a log NT-proBNP ratio. Clinical & echo variables were recorded. Primary endpoint was death, appropriate implantable defibrillator (ICD) discharge or heart transplant.

Results
NT-proBNP ratio was high in 473 and low in 304 patients. Median [interquartile range] LVEF, LVOTG & NT-proBNP were 61% [59, 66], 7 [4, 12] mm Hg & 481 [137–1361] pg/dl. 31% had functional class ≥II & 32% had ≥1 sudden cardiac death risk factor. At 5.3 [3–9] years, 139 (18%) met the primary endpoint (107 deaths). On spline analysis, log NT-proBNP ratio &gt;2.75 was associated with higher events. Cox & Kaplan-Meier survival analyses showed that high NT-proBNP ratio was independently associated with events (Figures 1A-B). In the subgroup of asymptomatic patients, NT-proBNP ratio remained associated with the primary outcome (adjusted HR 1.45, 95% CI 1.10–1.93, P=0.009).

Conclusions
Higher NT-proBNP ratio (&gt;2.75) is independently associated with adverse outcomes in nHCM, including asymptomatic patients, suggesting risk stratification even in earlier disease stages.

Funding Acknowledgement
Type of funding sources: None.
Cardiac reverse remodelling by 2D and 3D echocardiography in heart failure patients treated with sacubitril/valsartan: a prospective study
Authors: Mantegazza V , Volpato V , Mapelli M , Sassi V , Salvioni E , Mattavelli I , Tamborini G , Agostoni P , Pepi M 
Published: October 2021

Abstract

Background
Left ventricular (LV) reverse remodelling induced by sacubitril/valsartan (S/V) has been shown in heart failure patients with reduced ejection fraction (HFrEF) by two-dimensional (2D) transthoracic echocardiography (TTE). Data about S/V effect on the right ventricle (RV) are scarce.

Aims
We aimed to evaluate S/V-induced changes in NT-proBNP levels, and cardiac remodelling indices by 2D and three-dimensional (3D) TTE in HFrEF patients, classifying patients according to aetiology.

Methods
We prospectively enrolled 51 HFrEF patients (24 ischaemic, 27 non-ischaemic). At baseline and at 6-months follow-up (6MFU) after S/V treatment optimization, we i) assessed NT-proBNP; ii) performed 2D TTE according to guidelines for the assessment of biventricular size and function, mitral regurgitation grade and LV diastolic function; and iii) performed 3D TTE, using the Dynamic HeartModel software for the evaluation of LV volumes and function, the 4D LV-Analysis software for the assessment of LV longitudinal strain, and the 4D RV-Analysis software for the assessment of RV volumes and function (Figure 1).

Results
In non-ischaemic patients, both 2D and 3D TTE showed an improvement in LV volumes and biventricular function, whereas only 3D detected a reduction in RV size at 6MFU vs baseline (Table 1). In ischaemic patients, only 3D TTE showed an improvement in biventricular size and LV function (Table 1). Finally, S/V induced a significant improvement in NT-proBNP (Table 1) and diastolic function both in ischaemic and non-ischaemic groups: patients with elevated left atrial pressure (as assessed by 2D parameters of diastolic function) decreased from 45% to 20% in ischaemic and from 40% to 10% in non-ischaemic patients (p&lt;0.05).

Conclusions
S/V induced a significant improvement in NTproBNP and diastolic function in both aetiologic groups. A clinically significant improvement in biventricular function was shown only in non-ischaemic patients. 3D TTE may be advantageous to ascertain subtle changes in LV size and function, undetected by 2D imaging, and to evaluate RV dimensions and function, which have a major impact on HFrEF prognosis.

Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
Impact of decreased lymphocyte, total cholesterol, and albumin levels at discharge on all-cause death in patients with acute heart failure
Authors: Kato T , Yaku H , Yamamoto E , Inuzuka Y , Tamaki Y , Ozasa N , Kimura T 
Published: October 2021

Abstract

Background
Lymphocyte, total cholesterol, and albumin levels consist of Controlling Nutritional Status (CONUT) score, which has been reported to prognosticate patients with acute heart failure (AHF). However, the influence of each component of CONUT score on outcomes in patients with AHF was not fully elucidated.

Purpose
We aimed to evaluate the prognostic implication of the decrease in lymphocyte, total cholesterol, and albumin levels in patients with AHF.

Methods
We analyzed 1812 AHF patients in whom data at discharge were available from a multicenter registry. The decrease of lymphocyte (Ly) count was assigned with Ly≥1600/mL (31.0%), 1200≤ Ly &lt;1600 (26.9%), 800≤ Ly &lt;1200 (28.6%), Ly &lt;800 (13.5% of patients). The decrease of total cholesterol (TC) was assigned with TC≥180mg/dL (28.9%), 140≤ TC &lt;180 (42.2%), 100≤ TC &lt;140 (26.7%), TC &lt;100 (2.1% of patients). The decrease of albumin (Alb) was assigned and doubled with Alb≥3.5g/dL (45.7%), 3≤ Alb &lt;3.5 (35.1%), 2.5≤ Alb &lt;3 (15.2%), Alb &lt;2.5 (3.9% of patients). The primary outcome measure was all-cause death after discharge from the index hospitalization. Cumulative incidences were estimated by the Kaplan-Meier method and differences were assessed with the log-rank test. We constructed multivariable Cox proportional hazard models to estimate the risk of the decrease in each value per grade, with the results expressed as the hazard ratios (HRs) and 95% confidence intervals (CIs).

Results
Cumulative one-year incidence of the all-cause death was higher with decreasing Ly, TC, and Alb levels (P&lt;0.0001, P&lt;0.0001, and P=0.02, respectively) (Figure 1). The adjusted hazard ratio for all-case death per grade decrease is most prominent in albumin (HR: 1.36, 95% CI: 1.20–1.54), followed by lymphocyte count (HR: 1,23, 95% CI: 1.10–1.38), whereas it became insignificant in total cholesterol (HR: 1.05, 95% CI: 0.91–1.21).

Conclusions
The prognostic implications after discharge were different in albumin, lymphocyte count, and total cholesterol in patients with AHF.

Funding Acknowledgement
Type of funding sources: None. Figure 1
How predict right ventricular-pulmonary circulation coupling improvement in chronic heart failure
Authors: Santiago-Vacas E , Domingo M , Codina P , Cediel G , Spitaleri G , Zamora E , Gual F , Teis A , Santesmases J , Velayos P , Pulido A , Crespo E , Nunez J , Lupon J , Bayes-Genis A 
Published: October 2021

Abstract

Background
Right ventricular-pulmonary circulation coupling (RVPAC), which can be measured by the relation between tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (SPAP) by echocardiography, has been postulated as an independent prognostic factor of hospitalizations and mortality in heart failure (HF) patients.

Purpose
Our aim was to know the predictors of RVPAC improvement in a chronic HF cohort.

Methods
Retrospective analysis of a prospectively studied cohort of HF outpatients of different aetiologies attended in a multidisciplinary HF Unit. Prospectively scheduled echo-Doppler studies were performed at first visit and 1 year. A TAPSE/SPAP ratio &lt;0.36 mm/mmHg was identified as the most deleterious. Significant RVPAC improvement at 1 year was defined as TAPSE/SPAP ratio ≥0.36 mm/mmHg together with a ≥10% improvement from baseline RVPAC. Multivariable logistic regression analysis (conditional backward stepwise) was performed to select variables independently associated with significant RVPAC improvement. A predictive model including age and the previously selected variables was created.

Results
From August 2001 to July 2017, 554 patients with TAPSE and SPAP data in the initial visit were included. Mean follow-up time was 4.6±3.7 years. At first visit 252 (45.5%) patients had RVPAC &lt;0.36 mm/mmHg. Out of them, RVPAC at 1 year improved in 55 (21.8%). In multivariable analysis, the presence of baseline atrial fibrillation/flutter (OR 0.12 [95% CI 0.05–0.28], p&lt;0.001), SPAP (OR 0.96 [95% CI 0.92–0.99], p=0.014) and female gender (OR 0.34 [95% CI 0.12–0.91], p=0.03) were related to lesser probability of RVPAC improvement at 1 year. A model with such variables, together with age, showed an AUC of 0.824 to predict significant RVPAC improvement.

Conclusions
Atrial fibrillation/flutter, increasing SPAP and female gender hamper RVPAC improvement at 1 year in HF patients with baseline TAPSE/SPAP ratio &lt;0.36.

Funding Acknowledgement
Type of funding sources: None. Multivariate regression analysis