bluuebunny/crossref_metadata_2025_split huggingface dataset:
Sex differences in incidence of out-of-hospital cardiac arrest across ethnic and socioeconomic groups: a population-based cohort study in the Netherlands
Authors: Bolijn R , Sieben C.H.A.M , Kunst A.E , Blom M , Tan H.L , Van Valkengoed I.G.M 
Published: October 2021

Abstract

Background
Current out-of-hospital cardiac arrest (OHCA) prevention strategies are suboptimal due to the inability to identify subgroups at high risk. Insight into the occurrence of OHCA within general populations may help to target prevention strategies. Case registries suggest that there may be substantial differences in emergency medical service (EMS)-attended OHCA incidence between men and women. However, due to a lack of individual-level prospective data, relative sex differences across ethnic groups and socioeconomic (SES) groups have not been studied.

Purpose
We investigated sex differences in OHCA incidence, overall and across ethnic groups and SES groups.

Methods
We performed a retrospective population-based cohort study, combining individual-level data on ethnicity and income (as SES measure) from Statistics Netherlands of all men and women aged ≥25 years living in one study region in the Netherlands on 01–01–2009 (n=1,688,285) with prospectively collected EMS-attended OHCA cases (n=5,676) from the ARREST registry until 31-12-2015. We calculated age-standardised incidence rates of OHCA. Sex differences were assessed with Cox proportional hazards regression analyses, adjusted for age, ethnicity and income, in the overall population, and across ethnic and SES groups.

Results
Overall, the age-standardised incidence rate of OHCA was lower in women than in men (30.9 versus 87.3 per 100,000 person-years), corresponding with a hazard ratio (HR) of 0.33 (95% confidence interval [CI] 0.31–0.35). While incidence rates varied across subgroups (range: 22.6–104.6 per 100,000 person-years), the sex differences in hazard for OHCA existed in all income quintiles (HR range: 0.30–0.35) and ethnic groups (HR range: 0.19–0.40), except among Moroccans (HR 0.89, 95% CI 0.51–1.57).

Conclusion
In most ethnic groups and all SES groups, women have a substantial, yet lower OHCA incidence rate than men. This confirms that men are an important target group for OHCA prevention strategies across social strata. Nevertheless, considering potentially differential aetiology as well as the lower survival rates among women, women will also benefit from targeted prevention strategies.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme under acronym ESCAPE-NET (grant number 733381) and the COST Action PARQ (grant agreement number CA19137).ZonMw Gender and Health (grant number 8492ehab724.06458) and Gender and Prevention (grant number 555003016) programmes.
Single-chamber transvenous and subcutaneous defibrillators: clinical outcomes
Authors: Bodin A , Clementy N , Bisson A , Pierre B , Herbert J , Babuty D , Fauchier L 
Published: October 2021

Abstract

Introduction/Background
By using an entirely extra-thoracic lead placement, subcutaneous implantable cardioverter–defibrillators (S-ICD) were designed to avoid lead-related complications of single-chamber transvenous implantable cardioverter-defibrillators (VVI ICD).

Purpose
Our objective was to assess and compare outcomes following first VVI ICD or S-ICD implantation in an exhaustive nationwide matched cohort.

Methods
This French longitudinal cohort study was based on the national hospitalization database covering hospital care from for the entire population. All adults (age ≥18 years) hospitalized in French hospitals From January 1, 2010 to September 1, 2020, who underwent a VVI ICD or S-ICD implantation were included. Patients with a previous pacemaker or ICD or with a history of infective endocarditis were excluded.

Results
21,667 patients were included in the cohort, 19,493 patients had a transvenous VVI ICD and 2,174 had a subcutaneous ICD.
Mean follow-up was 28.8±31.8 months. S-ICD patients was associated with higher rate of all-cause death (HR: 1.684, 95% CI: 1.309–2.165, p&lt;0.001). There were no significant differences in cardiovascular death (HR: 1.092, 95% CI: 0.697–1.711, p=0.70) and infective endocarditis (HR: 0.354, 95% CI: 0.067–1.433, p=0.15) between the two groups
Using propensity score, 1,582 patients with VVI ICD were matched 1:1 with S-ICD patients. Mean follow-up was 4.5±7.2 months. In the matched analysis, there were no significant differences in all-cause death (HR: 1.090, 95% CI: 0.728–1.633, p=0.68) and cardiovascular death (HR: 1.167, 95% CI: 0.603–2.260, p=0.65) between the two groups. A trend toward a lower risk of infective endocarditis in the S-ICD group was also observed without reaching significance (HR: 0.219, 95% CI: 0.047–1.017, p=0.053).
A sensitivty analysis in patients with coronary artery disease in the matched cohort was performed. 1,024 patients had a VVI ICD and 977 had a S-ICD. Same trends were observed without significant differences in all-cause death (HR: 0.966, 95% CI: 0.605–1.543, p=0.88) and cardiovascular death (HR: 1.307, 95% CI: 0.610–2.799, p=0.49).

Conclusion
Our nationwide study highlighted a higher risk of all-cause death in patients treated with subcutaneous which however was not statistically significant after propensity score matching. No differences regarding cardiovascular mortality was found. An interesting trend toward diminution of infective endocarditis was also observed without reaching significancy.

Funding Acknowledgement
Type of funding sources: None. Baseline characteristicsCardiovascular death
Hemodynamic arterial changes in heart failure. a proposed new paradigm of heart and vessels failure. The Copernican revolution?
Authors: Galati G , Germanova O , Iozzo R.V , Buraschi S , Shchukin Y.V , Germanov A , Germanov V , Tereshina O , Senni M , Margonato A 
Published: October 2021

Abstract

Background
Although heart failure (HF) is one of the most common conditions affecting the heart, little attention has been placed on the role of arteries in contributing to the progression of this disease.

Purpose
We sought to determine the hemodynamic change of arteries in HF patients subdivided according to left ventricular ejection fraction. The major goal was to establish the active compensatory role of arteries in HF

Methods
Using sphygmography, we systematically studied a cohort of 228 HF patients and 52 healthy controls. We focused on the common carotid as the main elastic artery and the posterior tibial as the main muscular artery (Figure 1). Moreover, we categorized the three HF groups, HFrEF, HFmrEF, HFpEF, into two subgroups (A and B) according to the presence or absence of HF signs at baseline.

Results
We discovered that all the parameters of measured arterial kinetics, i.e., work, power, acceleration, and speed, were significantly increased (p&lt;0.001 by one-way ANOVA) in the groups without HF signs. In contrast, all the arterial kinetics parameters were significantly reduced (p&lt;0.001) in the groups exhibiting HF signs. Similar results were obtained in both types of arteries and were consistently observed across all the three different types of HF, although with some differences in magnitude. Finally, we discovered that HFpEF patients exhibited more compromised arterial function vis-à-vis HFrEF patients (Figure 2: Patients Disposition (Top) and Quantification of arterial kinetics and hemodynamic parameters (Down) from the common carotid artery [A] and the posterior tibial artery [B]).

Conclusions
We provide the first documentation of an active compensatory role of arteries during HF. Mechanistically, we explain these findings by a dual activity of large arteries accomplished via an active propulsive work and a concurrent hemodynamic suction. These underestimated arterial functions partially compensate for the heart dysfunction in HF, underlining a key interplay between the heart and the vessels. We propose a new paradigm that we define as “heart and vessels failure” that explicitly focuses on both heart and vessels' interaction during the progression of HF.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Sphygmograms of CCA and PTAFigure 2. Patients disposition & Results
Low-carbohydrate diets and right ventricular structure and function: the MESA-Right Ventricle study
Authors: Zhuang Z.X.D , Lai Y.H , Zhang S.Z , Liao X.X 
Published: October 2021

Abstract

Background
The association between daily carbohydrate intake and right ventricular (RV) morphology has not been well studied. We aimed to figure out the relationship between daily carbohydrate intake and right ventricular structure and function in a large multiethnic population-based cohort.

Methods
The Multi-ethnic Study of Atherosclerosis (MESA) -Right Ventricle Study measured RV mass and volumes by cardiac MRI in participants aged 45 to 84 years without clinical cardiovascular disease (CVD) in the MESA study. Participants were divided into three groups based on average daily carbohydrate intake: low (≤45%), medium (45–55%), and high (≥55%).

Results
The study sample included 3,776 participants which were aged 61.5±10.1 years, 47.5% male, 40.0% white, 24.9% African American, 21.8% Hispanic, and 13.3% Chinese. Higher levels of daily carbohydrate intake were linearly associated with greater RV stroke volume (RVSV), and RV ejection fraction (RVEF) (P&lt;0.001) with larger carbohydrate-intake-related increasements in men than in women (P=0.006 for interaction) after adjusting for demographics, anthropometrics, smoking, drinking, daily protein intake, daily total energy intake, cholesterol, diabetes mellitus, hypertension, education, utilization of medicine and other covariates. The results remained significant after adjustment for LV parameters.

Conclusions
Carbohydrate intake was independently associated with differences in RV morphology after adjustment for all covariates. This association may be explained by the decreased intake of specific nutrients from carbohydrates. Given the nature of the study, causality cannot be proven. Therefore, further studies are needed to extend these findings, which if confirmed, may suggest a need to rethink recommendations for carbohydrate intake in clinical practice, for optimal nutrient achievement, meals need to be well formulated.

Funding Acknowledgement
Type of funding sources: None.
Pill burden and out-of-pocket medication costs of a contemporary heart failure with reduced ejection fraction cohort
Authors: Oliveira Campinas A , Costa R.C , Dias De Frias A.D.F , Alexandre A.A , Gomes C.G , Santos M.S , Torres S.T 
Published: October 2021

Abstract

Introduction
Modern pharmacological treatment of heart failure with reduced ejection fraction (HFrEF) dramatically improves its prognosis. However, the increasingly complexity and associated costs might threat their effective uptake in clinical practice. We aimed to study the pill burden and out-of-pocket costs of cardiovascular drug therapy of a contemporary cohort of HFrEF patients.

Methods
We performed a retrospective, cross-sectional, single-center study on a convenience sample of 100 consecutive HFrEF patients assessed at our HF outpatient clinic (January-June 2020). The pill burden was assessed by the number of prescribed different cardiovascular drugs and pills per day. The out-of-pocket (OOP) costs were defined using the total patients co-payment of cardiovascular medications per month of treatment, taken in account the exemptions provided by the Portuguese National Health System (NHS). The included drug classes were antiplatelets, anticoagulants, statins, HF drugs (Beta-blockers [BB], angiotensin-converting enzyme inhibitors [ACEi]/ angiotensin receptor blockers [ARBs]/ angiotensin receptor-neprilysin inhibition [ARNI], mineralocorticoid antagonists [MRA], sodium glucose cotransport inhibitors [iSGLT2], digoxin, loop diuretic) and antiarrhythmics.

Results
The mean age was 62±12 years and only 24% were female. The etiology of HF was ischemic in 42% of the patients, 86% were in NYHA II class and 5% in NYHA III-IV. The mean LVEF was 34±5% and the median NT-proBNP was 482 pg/mL [172–1120]. 92% of patients were on BB, 67% on ACEI/ARBs, 25% on ARNI, 81% on MRA and 30% on iSGLT2. The use of implantable cardioverter-defibrillators was 38% and 20% of patients were resynchronized. The number of cardiovascular (CV) drugs per day was 5.4±1.6 per patient and the number of CV pills per day was 6.6±2. Most patients (65%) had low income and had the maximal exemption on medication costs provided by NHS. Overall, the mean OOP costs was €16.1 per month of treatment and the mean OOP costs for patients exempted and not exempted was €12.9 and €22.3, respectively. The mean OOP costs of evidence-based HF-modifying drugs (BB, ACEI/ARBs, ARNI, MRA, iSGLT2) was €10.1 and the mean OOP costs of evidence-based HF-modifying drugs for patients exempted and not exempted were €7.9 and €14.2, respectively. However, for patients on ARNI the mean OOP costs was almost 3 times higher (€33.6).

Conclusions
In this optimally treated contemporary cohort of HFrEF, the pill burden due to cardiovascular therapy only is high (7 pills/day). With the exception of patients on ARNI, the overall OOP costs of HF-modifying prognostic drugs are low.

Funding Acknowledgement
Type of funding sources: None.
Peripheral artery disease is associated with adverse outcome among hospitalized patients with decompensated heart failure
Authors: Itelman E , Maor E.M , Kuperstein R.K , Freimark D.F , Matetzky S.M , Mazin I.M 
Published: October 2021

Abstract

Patients with heart failure (HF) and peripheral artery disease (PAD) share common high co-morbidities and outcomes. Management of HF patients has changed dramatically in the last decade. Our purpose in this analysis was to describe the prognostic significance of PAD in a large contemporary cohort of HF patients.

Methods
Analysis included consecutive patients who were hospitalized with decompensated HF between 2008–2020 at our Center. All patients' records were reviewed for the presence of PAD. Patients with cancer or chronic obstructive pulmonary disease were excluded from the analysis. Study outcomes were all-cause mortality and HF hospitalizations. Cox regression and propensity score matching models were applied.

Results
Final study population included 8,216 patients of whom 548 (7%) had PAD. Patients with PAD had higher rates of co-morbidities. Median follow-up was 3 (IQR 1–7) years. PAD was associated with a significant 35% increased risk of re-admission and mortality in univariate analysis (p&lt;.001 for both). Propensity score matching analysis has demonstrated that PAD patients had similar mortality rates, but higher re-hospitalization rates during follow up. Finally, sensitivity analysis of the matching model (n=474), after excluding patients with RV dysfunction or severe pulmonary hypertension, successfully showed that HF patients with PAD were 50% more likely to be re-admitted and 30% more likely to die during follow-up (p=0.02 and 0.006 respectively; Figure 1)

Funding Acknowledgement
Type of funding sources: None. Figure 1
Predictive ability of cardiopulmonary exercise test parameters in heart failure patients with cardiac resynchronization therapy
Authors: Dias Ferreira Reis J.P , Goncalves A , Bras P , Moreira R , Rio P , Pereira Silva T , Timoteo A , Soares R , Cruz Ferreira R 
Published: October 2021

Abstract

Introduction
There is evidence suggesting that a peak oxygen uptake (pVO2) cut-off of 10ml/kg/min provides a more precise risk stratification in Cardiac Resynchronization Therapy (CRT) patients. Our aim was to compare the prognostic power of several cardiopulmonary exercise testing (CPET) parameters in patients with CRT and assess the discriminative ability of the guideline-recommended pVO2 cut-off values.

Methods
Prospective evaluation of consecutive heart failure (HF) patients with left ventricular ejection fraction ≤40%. The primary endpoint was a composite of cardiac death and urgent heart transplantation (HT) in the first 24 follow-up months and was analyzed by several CPET parameters for the highest area under thecurve (AUC) in the CRT group. A survival analysis was performed to evaluate the risk stratification provided by several different cut-offs.

Results
A total of 450 HF patients, of which 114 had a CRT device. These patients had a higher baseline risk profile, but there was no difference regarding the primary outcome (13.2% vs 11.6%, p=0.660). End-tidal carbon dioxide pressure at the anaerobic threshold (PETCO2AT) had the highest AUC value, which was significantly higher than that of pVO2 in the CRT group (0.951 vs 0.778, p=0.046). The currently recommended pVO2 cut-off provided accurate risk stratification in this setting (p&lt;0.001),and the suggested cut-off value of 10 ml/min/kg did not improve risk discrimination in device patients (p=0.772).

Conclusion
PETCO2AT outperforms pVO2's prognostic power for adverse events in CRT patients. The current guideline-recommended pVO2 cut-off can precisely risk-stratify this population.

Funding Acknowledgement
Type of funding sources: None.
Discongruence Index: predictor of prosthesis size loss after transcatheter aortic valve replacement
Authors: De Agustin Loeches J.A , Pozo E , Nombela- Franco L , Jimenez-Quevedo P , Tirado G , Mahia P , Marcos-Alberca P , Luaces M , Perez De Isla L , Gomez De Diego J.J , Cobos M.A , Islas F , Fernandez-Ortiz A , Villacastin J , Macaya C 
Published: October 2021

Abstract

Introduction
Prosthesis under-expansion has been associated with higher rates of complications and worse long term outcome after transcatheter aortic valve replacement (TAVR). The objective of the current study was to assess the value of a new “Discongruence index”, to predict the percentage of prosthesis size loss (compared to its nominal size). The “discongruence index” is obtained from the relation between transcatheter valve size and the patient body surface area.

Methods
A total of 247 consecutive patients with severe aortic stenosis that underwent TAVR with balloon expandable Edwards-Sapiens prosthesis or CoreValve Revalving system at our institution were included. The “Discongruence index” was calculated pre-procedurally as the ratio: selected transcatheter valve size (mm) / body surface area (cm2). Two-dimensional transesophageal echocardiography images were studied in the 120–135° plane after the prosthesis deployment, and the maximum anteroposterior diameter was measured (in millimeters). From this measurement was obtained the percentage of prosthesis size loss (compared to the prosthesis nominal size).

Results
Mean age was 82±6 years and 102 patients (41.3%) were men. Mean aortic valvular area before TAVR was 0,87±3,8 cm2, (indexed 0,36±0,1 cm2) and the mean aortic gradient 49,1±16,9 mmHg. Mean prosthesis maximum deployment was 18,9±2,7 mm; absolute loss of prosthesis size compared to nominal 6,5±2,8 mm and the percentage loss of prosthesis size 25.1±9,5%. The “Discongruence index” was predictor of the percentage of prosthesis size loss (y = 5,7650 + 1,3010x, p&lt;0,001), see figure.

Conclusions
The “Discongruence index” is a useful tool to predict the percentage of prosthesis size loss after TAVR. This new index should be taken into consideration in the selection of transcatheter valve sizes to avoid prosthesis under-expansion.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Area strain predicts clinical course in patients with heart failure with midrange ejection fraction
Authors: Tunyan L.G , Chilingaryan A , Sisakyan J.G , Tumasyan L.R , Kzhdryan H.K , Zelveyan P.H 
Published: October 2021

Abstract

Heart failure with midrange ejection fraction (HFmrEF) as a relatively new category remains understudied. Some studies have shown that patients with HFmrEF more resemble to those with heart failure with reduced ejection fraction (HFrEF), but many patients with HFmrEF are able to improve their EF to preserved one. The transformation course is hard to predict. We assumed that novel strain parameters might predict this transformation.

Methods
73 patients with HFmrEF NYHA II-III, 62±5 years (32 female) on optimal medical therapy and 43 age and sex matched healthy controls were involved in the study. Global values of longitudinal (GLS), circumferential (GCS) and radial strain (GRS), left ventricular torsion (LVT), peak LV twist (LVTR) and untwist rates (LVUTR), and area strain (AS) were measured by 2D/3D echocardiography and analyzed offline by one experienced specialist. All measurements were done at the study onset and in 1 year follow up.

Results
Patients with HFmrEF had significantly lower absolute values of GLS, GCS, GRS, LVT, LVTR, LVUTR and AS compared with controls. In one year follow up 24 (37%) patients with HFmrEF moved into HFrEF category and 14 (19%) moved up to HFpEF and the rest of the patients remained in HFmrEF group. Patients with HFrEF had significantly lower absolute values of AS, LVT, LVTR and LVUTR compared with patients who remained in HFmrEF group and patients that moved to HFpEF category, whereas patients with HFpEF had greated absolute values of GRS, AS and LVT, and without differences in LVTR and LVUTR compared with patients with HFmrEF. (HFrEF AS: −16.31±3.21% vs −22.34±6.31%, p&lt;0.01; LVT: 0.72±0.13°/cm vs 1.12±0.42°/cm, p&lt;0.03; LVTR 29.31±11.23°/s vs 48.32±19.71°/s, p&lt;0.03; LVUTR 25.33±12.41°/s vs 49.23±18.34°/s, p&lt;0.03; HFpEF AS: −31.23±4.35% vs −23.34±6.31%, p&lt;0.01; LVT: 1.93±0.13°/cm vs 1.12±0.42°/cm, p&lt;0.03; LVTR 41.62±15.81°/s vs 48.32±19.72°/s, p=0.08; LVUTR 41.41±16.72°/s vs 49.22±18.31°/s, p=0.12, GRS 45.34±7.41% vs 29.42±5.81%, p&lt;0.002). Patients with subsequent HFrEF transformation also had lower AS values at beseline (−17.31±4.21% vs −24.21±6.83%, p&lt;0.002). AS was the only predictor of HFmEF transformation into HFrEF or HFpEF with cut off values −17.1% and −32.7% respectively, (area under the curve 0.834)

Conclusion
Patients with HFrEF move into HFrEF category more frequently than into HFpEF. AS predicts transformation of HFmEF into HFrEF or HFpEF.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): City Hall resources