bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of soluble ST2, M235T polymorphism of ATG with insulin resistance in diabetic patients with heart failure with preserved ejection fraction
Authors: Medentseva O , Rudyk I.S , Ovrakh T.G , Gasanov I.C , Babichev D.P , Bondar T.N 
Published: October 2021

Abstract

Background
It has been shown that the level of the soluble form of suppression of tumorigenicity 2 (sST2) is associated with an unfavorable course of heart failure (HF). On other hand, has been shown a strong influence of ATG polymorphism on HF development. However, the association of M235T polymorphism of ATG and sST2 level with insulin resistance in diabetic patients with HF with preserved ejection fraction (HFpEF) is still unknown.

Purpose
To investigate the association between sST2, different types of M235T polymorphism of ATG and insulin resistance in patients with HFpEF and T2DM.

Methods
A total of eighty-one patients (49 females and 32 males; mean age 62,5±7,3 years) with HFpEF and type 2 diabetes mellitus (T2DM) were examined. Twenty patients had MM genotype, 38 patients had MT genotype and 23 had TT genotype of M235T polymorphism of ATG, which was determined by using of polymerase chain reaction. sST2 was determined by using kits of reagents “PresageST2” (USA). The mean value of sST2 was determined, patients were divided according to the mean. The HOMA-IR was calculated to determine insulin resistance. All statistical tests were 2-tailed and performed in Statistica 10.0, p&lt;0.05 was considered statistically significant.

Results
In the group of HFpEF and T2DM with sST2&gt;24.4 ng/ml the HOMA-IR was significantly higher than in the group with sST2&lt;24.4 ng/ml and was 16.24±1.22 and 9.30±1.30, respectively (p&lt;0.05).
The HOMA-IR was higher in the TT genotype group compared with carriers of M allele. (p&lt;0.05) (Table 1).

Conclusion
High circulating level of sST2 and TT genotype of the M235T polymorphism of the ATG presence was associated with increased insulin resistance in patients with HFpEF and T2DM.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): government funding Table 1
Disproportionate mitral regurgitation is associated with survival in acute heart failure with moderate range ejection fraction
Authors: Berrill M , Ashcroft E , John I , Baltabaeva A 
Published: October 2021

Abstract

Background
In acute heart failure (AHF) with moderate-range ejection fraction (HFmrEF) the effect of mitral regurgitation (MR) is uncertain.

Methods
103/440 consecutive patients in AHF had HFmrEF. They underwent bedside echocardiography within 24 hours of recruitment, prior to offloading, and were followed up for 2 years. The endpoint was all-cause mortality at 2 years. A novel proportionality index - where the effective regurgitant orifice is divided by the left ventricular end-diastolic volume (ERO/LVEDV)) - identified HFmrEF patients with disproportionate MR.

Results
103/440 (23.4%) patients had HFmrEF with an average EF of 44.6±2.6%. 54.4% were male, with an average age of 80.5±11.4. 47.6% had a previous diagnosis of hypertension, 28.2% diabetes and 10.7% cerebrovascular disease. Patients did not present in shock, with average systolic/diastolic blood pressures of 141.7±26.2mmHg/ 78.5±19.3mmHg, nor did they primarily present with severe infections with mean CRP of 23.2±31.7. BNP at presentation was 1179.8±1028.5ng/L. Every patient had MR, 78/103 (75.7%) had MR quantifiable by PISA. 54/78 (69.2%) had disproportionate MR, defined by an ERO/LVEDV &gt;0.14mm2/ml. When compared to proportionate MR, disproportionate MR in HFmrEF was associated with: greater LVEDV (136.3±53.6ml vs. 103.3±39.7ml [p=0.018]), greater mitral regurgitant volumes (41.8±18.5ml vs. 21.5±12.5ml [p&lt;0.001]) and systolic pulmonary artery pressures (60.2±21.0mmHg vs. 48.0±14.7mmHg [p=0.012]) but not left-atrial size (30.2±7.1mm2 vs. 30.2±7.8mm2 [p=0.915]). Disproportionate MR in HFmrEF was also associated with worse 2-year outcome than proportionate MR – 40.1% vs. 16.7% (HR 2.30; 95% CI 1.02–5.17 [p=0.045].

Conclusion
This is the first assessment of the effect of disproportionate volume loading secondary to MR in patients presenting in AHF with HFmrEF. Disproportionate MR was associated with worse outcome at 2 years.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
Eco color doppler evaluation of renal hemodynamic in the prognosis of acute heart failuree
Authors: Turrini F , Galassi M , Sacchi A , Ricco' B , Messora R , Bertolotti M , Pinelli G ,   VERDETA' group (VEnous Renal Doppler Evaluation of acute hearT fAilure
Published: October 2021

Abstract

Background
Elevation of right atrial pressure is a typical feature of acute heart failure (AHF), it is transmitted to renal veins leading to persistent kidney congestion. We aimed to evaluate the role of Doppler ultrasound in monitoring kidney congestion during diuretic therapy.

Methods
71 patients (26 F - mean age 80.8±8.2 - mean EF 0.40±13.2) admitted for AHF underwent cardiac and renal Echo Doppler examination at day 1–3–5 of Hospital stay. Parameters of arterial and venous flow within cortical right kidney were recorded. Venous Doppler Profile (VDP) was classified as: continuous (C), pulsatile (P), biphasic (B) or monophasic (M) according to the growing degree of derangement. Arterial resistive index (RI) &gt;0.8 was considered elevated. Correlation between renal hemodynamic changes and clinical outcome (Death and cardiovascular (CV) hospitalization) at 60 days was sought.

Outcome
VDP derangement (M or B) was detected in 57 patients (80.3%) at day 1 and in 36 at day 5 (52.2%, p &lt;0.05). RI was elevated in 43 patients (61.4%) at day 1 and in 28 patients at day 5 (43.8%, p&lt;0.05). Patients with deranged VDP on admission, had higher pulmonary artery sistolic pressure (PASP) (53±10 vs 39±17 mmHg, p&lt;0.05) but similar EF, BNP and GFR values. Patients with elevated RI on admission exhibited lower GFR (47.6±23.8 vs 60.7±19.1 ml/min/1.73 m2, p&lt;0.05) but similar EF, BNP and PASP values. At day 5, 41 (57.7%) patients had VDP improved of at least one class or continuous VDP (Table 1).
After 60 days, 13 (18.3%) patients died and 8 (11.3%) had a CV hospitalization. Kaplan Meier analysis found a significant better outcome in those patients whose VDP did improve after diuretic therapy (Log Rank test p&lt;0.05 – Figure 1).

Conclusions
Most patients admitted with AHF present deranged VDP. Diuretic treatment lead to VDP improvement and to renal RI decrease. In this perspective study, for the first time VDP improvement after endovenous diuretic treatment resulted associated to reduced risk of death and CV Hospitalization.
Evaluation of VDP could become a useful tool in monitoring the efficacy of diuretic treatment in AHF.

Funding Acknowledgement
Type of funding sources: None. Table 1. Patients characteristics and VDPFigure 1. Kaplan-Meier estimate curve
Discordance in prognostic ability between physician assessed NYHA classification and self-reported health status in patients with acute heart failure
Authors: Belkin M , Wussler D , Kozhuharov N , Strebel I , Walter J , Michou E , Goudev A , Menosi Gualandro D , Maeder M , Kobza R , Rickli H , Breidthardt T , Muenzel T , Erne P , Mueller C ,   Cardiovascular Research Institute Basel
Published: October 2021

Abstract

Background
Especially in patients with acute heart failure (AHF) the NYHA classification remains of uncertain representation of patients' actual health state. Alternatively, patient's subjective well-being, in terms of health-related quality of life (HRQL), showed to have an excellent prognostic ability in out clinic patients with chronic heart failure.

Objectives
It is unknown whether HRQL instruments can assess a more reliable prognostication in patients hospitalized due to AHF than the NYHA classification.

Methods
Goal Directed Afterload Reduction in Acute Congestive Cardiac Decompensation Study (GALACTIC) was a multicenter, randomized, open-label blinded-end-point trial that emphasized early intensive and sustained vasodilation in adult patients hospitalized due to AHF with NYHA functional class III/IV, however provided neutral findings. HRQL was assessed by the generic EQ-5D-3L which is a 3-leveled 5-item instrument and the disease-specific Kansas City Cardiomyopathy Questionnaire (KCCQ). Unadjusted and adjusted Cox regression models were performed after patients were grouped into low (EQ-5D −0.074&lt;0.25; KCCQ 0&lt;25), moderately low (0.25&lt;0.5; 25&lt;50), moderately high (0.5&lt;0.75; 50&lt;75) and high HRQL (0.75–1.0; 75–100).

Results
781 patients were enrolled in 10 centres in 5 countries over 2 continents among which 536 (69%) patientshad completed theEQ-5D and 419 (54%) the KCCQ shortly after admission. Within 180 days of follow-up69 (13%) and 54 (13%) patients died and 151 (28%) and 122 (29%) died or were rehospitalized due to AHF, respectively. Cumulative incidence as well as HRs in patients grouped according to NYHA (n=536) indicated a comparable or significantly lower risk in patients with NYHA IV: e.g. for the combined outcome HR 1.07 (95% CI 0.777–1.473) and aHR 0.463 (95% CI 0.245–0.875). Whereas HRs in patients grouped according to both, EQ-5D (n=536) and KCCQ (n=419), increased from the group with highest to the group with the lowest HRQL: e.g. aHR for moderately high 1.11 (95% CI 0.718–1.715), for moderately low 1.721 (95% CI 1.102–2.688) and for low EQ-5D index 1.891 (95% CI 1.136–3.149) referenced to high HRQL (EQ-5D index 0.75–1.0).

Conclusions
These findings corroborate and extend previous work suggesting that NYHA classification poorly discriminates AHF patients' prognosis and challenge its' extensive application. HRQL might be a possible alternative to easily assess these patients' heath state.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Swiss National Science Foundation, the Swiss Heart Foundation A. 180-day mortality; B. composite outcome
Natriuretic peptide dynamics with remote pulmonary artery pressure monitoring
Authors: Casquete D , Codina P , Domingo M , Santiago E , Cediel G , Spitaleri G , Zamora E , Santesmases J , Boldo M , Rivas C , Gonzalez B , Velayos P , Pulido A , Lupon J , Bayes-Genis A 
Published: October 2021

Abstract

Background
Real-life clinical practice has confirmed the value of pulmonary artery (PA) pressure-guided therapy in patients with heart failure (HF) and history of repeated HF hospitalizations (HFH), to greater extent to that reported in the pivotal clinical trial CHAMPION-HF. The value of hemodynamic monitoring in a population of patients with HF and elevated natriuretic peptides, but without recent HFH, is unknown.

Objective
To assess N-terminal-pro-brain natriuretic peptide (NTproBNP) dynamics before and 6 months after PA pressure sensor implantation.

Methods
Ten patients managed in a multidisciplinary HF clinic implanted with the CardioMEMS PA pressure sensor were consecutively included from June 2019 to July 2020. Mean age was 63.1±23.5 years, 30% were women, 40% had HF with reduced EF (EF &lt;40%). NTproBNP was measured at baseline and six months after sensor implantation. Wilcoxon matched-pairs signed-rank test was used to compare NTproBNP values at baseline and at 6 months. Fractional polynomial fit plot was used to represent changes in mean PA pressure over time. Linear regression was used to predict the change in NTproBNP based on the change in PA pressures.

Results
Mean daily pressure transmission rate was 92.4±5.1%. During the six-month study period 90% of patients had a change in medication related to PA pressure, with an average of 0.21 [0.17–0.66] changes per patient per month. Mean PA pressure at baseline was 28.5±9.5 mmHg, and decreased by 5.5 mmHg at 6 months (p=0.01) (Figure 1). NTproBNP was also significantly lower six months post CardioMEMS implantation; decreasing from 1696 pg/ml [976–2930] at baseline to 1046 pg/ml [616–2076] after six months (p=0.04) (Figure 2). There was a weak correlation between the change in NTproBNP and the change in mean PA pressure (R2=0.22, p=0.17).

Conclusions
NTproBNP values were significantly lower 6-months following implantation of a PA pressure sensor to guide HF management. Mean PA pressures were also significantly reduced.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitari Germans Trias i Pujol Figure 1. Change in mean PA pressure over time.Figure 2. Change in NTproBNP after PAP monitoring.
Temporal characteristics of duration of daily activity before and after heart failure hospitalizations in a large real-world population of patients with cardiovascular implanted electronic devices
Authors: Sarkar S , Koehler J 
Published: October 2021

Abstract

Background
Diagnostic parameters measured in implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRTD) have been shown to change before and after heart failure (HF) events with fluid overload.

Purpose
We investigated the temporal characteristics of device measured daily activity duration before and after HF events in a large real-world cohort of patients with ICD/CRTD devices.

Methods
We linked a de-identified database of aggregated electronic health record (EHR) data (2007–2017) to a manufacturer's device database with continuous diagnostic monitoring data. Patients with ICD/CRTD implants with HF diagnostic feature were included for this study. Device accumulates the total number of active minutes during a 24-hour period with an active minute defined as total number of accelerometer fluctuations reaching a threshold during the minute. HF event was defined as an inpatient, emergency department, or observation unit stay in a hospital with primary diagnosis of HF and intravenous diuretics administration. Temporal ensemble average of daily duration of activity in the 60 days pre and post HF events were compared between HF events with and without readmission within 60 days and with periods with no HF events during follow-up.

Results
A total of 17,886 patients with 1.8±1.2 years of follow-up met inclusion criteria. The average age of patients was 66.6±12.3 years, with 72% being males, and 51% with ICD devices. The average daily duration of activity in HF events with and without readmission and with no events is shown in Figure. A total of 1174 patients had 1425 HF events with no readmission for HF within 60 days and 282 patients had 295 HF events which were followed by readmission for HF within 60 days. A total of 17,839 patients had no HF events over 86,858 follow-up months. The 7-day average activity duration decreased by &gt;10 minutes in a large proportion of patients in the 30-day period before HF event compared to 30-day periods with no events (43% vs 34%; Odds Ratio: 1.52; p&lt;0.001). A 7-day average activity duration increase of &gt;10 minutes from admission to 30 days after admission happens in a smaller proportion of HF events with versus without HF readmission within 60 days of index admission (24% vs 31%; Odds Ratio: 0.7; p&lt;0.001).

Conclusions
In a large real-world population of patients with ICD/CRTD devices, the average daily activity duration reduces before HF events. Re-admissions are more likely in patients with smaller increase in activity duration post discharge.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic Plc
Efficacy of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency with and without anaemia: a subgroup analysis of AFFIRM-AHF
Authors: Filippatos G , Ponikowski P , Farmakis D , Metra M , Ruschitzka F , Van Der Meer P , Kirwan B.-A , MacDougall I C , Fabien V , Waechter S , Butler J , Anker S D , Jankowska E A ,   the AFFIRM-AHF investigators
Published: October 2021

Abstract

Background
Iron deficiency is associated with increased morbidity and mortality in patients with acute heart failure (HF), even in the absence of anaemia.

Purpose
This prespecified subanalysis of the AFFIRM-AHF trial investigated the effects of ferric carboxymaltose (FCM) on recurrent HF hospitalisations and cardiovascular (CV) mortality in patients with and without anaemia defined as baseline haemoglobin (Hb) &lt;12 g/dL, ≥12 g/dL.

Methods
In total, 1108 patients (558 FCM, 550 placebo) were included in the modified intention-to-treat AFFIRM-AHF analysis. The primary outcome was a composite of total HF hospitalisations and CV death, evaluated up to 52 weeks post-randomisation.

Results
Of the 1108 patients, 228 and 329 in the FCM group and 236 and 314 in the placebo group had Hb &lt;12 g/dL and ≥12 g/dL at baseline, respectively. For patients with a baseline Hb ≥12 g/dL, the total number of HF hospitalisations and CV death was 156 and 201 in the FCM and placebo groups, respectively, with a rate ratio (95% confidence interval) of 0.67 (0.48–0.93; p=0.016). For patients with Hb &lt;12 g/dL, this was 136 and 171 in the FCM and placebo groups, respectively (0.97 [0.66–1.41; p=0.862]). This treatment effect was consistent for all secondary outcomes in patients in the FCM group vs placebo, for both Hb subgroups (Figure).

Conclusion
Iron deficiency treatment with FCM following acute HF reduced the risk of HF hospitalisations and CV death, irrespective of Hb level at baseline.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Vifor Pharma Ltd. Figure 1
Association between the triglyceride-glucose index and a procoagulant state in coronary artery disease
Authors: Kosuta D , Novakovic M , Bozic Mijovski M , Fras Z , Jug B 
Published: October 2021

Abstract

Background
Metabolic risk factors and a procoagulant state represent major drivers of atherothrombosis. In terms of metabolic risk factors, the triglyceride-glucose (TyG) index has recently emerged as a marker of metabolic syndrome and an independent predictor of cardiovascular outcomes in patients with coronary artery disease (CAD). In terms of a procoagulant state, previous research suggests that CAD is associated with increased coagulation and impaired fibrinolytic activity, which may contribute to atherothrombotic events. We hypothesized that metabolic risk, as determined by TyG index, may be an important driver of hemostatic derangements in patients with CAD.

Purpose
We sought to establish a possible association between the overall hemostatic, coagulation and fibrinolytic potentials (OHP, OCP and OFP), and the TyG Index in patients with CAD.

Methods
Consecutive patients after a recent myocardial infarction (within 90 days from inclusion) had fasting blood samples withdrawn. OHP, OCP and OFP were determined with a previously validated method, using thrombin and recombinant tissue-type plasminogen activator, by absorbance measurements at 405 nm in 1 minute intervals for 40 minutes. Areas under the curve were constructed for OHP and OCP with the obtained measurements, OFP was calculated as the difference between the two aforementioned areas: OFP = [(OHP – OCP) / OCP] x 100 (%). Baseline data, cardiovascular risk factor profile and standard laboratory tests were collected. TyG index was calculated using the previously validated formula: TyG index = ln [triglyceride (mg/dL) x glucose (mg/dL) / 2]. Proportions were compared using the chi-squared test, linear regression models were constructed for the multivariate analysis.

Results
We included 117 patients (mean age 56±10 years, 20% women). Arterial hypertension was present in 86 (73.5%), diabetes mellitus in 10 (8.5%), dyslipidemia in 75 (64.1%), family history in 46 (39.3%) patients; 54 (46.2%) were active smokers (within 2 years). Median OHP was 8.0 (interquartile range [IQR] 2.9), OCP was 22.6 (IQR 6.2), OFP was 66.0 (IQR 11)%. The TyG index was a strong univariate predictor of OCP (Beta 2.26 [0.282–4.242] p=0.026), and retained its statistical significance after multivariate adjustment for sex, age and traditional risk factors (R2 0.23; ANOVA for regression p&lt;0.001; Beta 1.98 [0.13–3.84], p=0.036).

Conclusion
The TyG index, a marker of metabolic syndrome, is an independent predictor of a procoagulant state in CAD, as determined by the OCP. Our findings suggests that the metabolic syndrome may be an important driver of atherothrombotic risk in patients with CAD.

Funding Acknowledgement
Type of funding sources: None. Correlation between TyG index and OCP
Application of enhanced external counterpulsation in treating patients with stable ischemic heart disease
Authors: Karaganov K , Lishuta A , Belenkov Y 
Published: October 2021

Abstract

Introduction
Currently, enhanced external counterpulsation (EECP) is one of the safest non-invasive treatments for patients with coronary artery disease (CAD). In combination with traditional drug therapy, EECP can significantly improve the quality of life of patients by increasing coronary perfusion, improving myocardial contractile function, and improving endothelial function.

Aim
To study the effect of EECP on clinical status, quality of life (QL) and structural-functional state of blood vessels in patients with stable coronary artery disease.

Materials and methods
In the present study 67 CAD patients were included (average age 65.7±5.66 years; men 71.9%, angina pectoris of functional class II-III (FC)). All patients were on optimal medical therapy (ACE inhibitors, beta-blockers, antiplatelet agents, statins, nitrates), which remained unchanged during the follow-up. Patients were given a course of EECP (35 procedures 220–280 mmHg.art.). Test 6-minute walk (T6MW), QL (Minnesota Satisfaction Questionnaire (MSQ)), echocardiography (ejection fraction of the left ventricle (LVEF)) were performed at baseline and after 6 months. In addition, all the patients underwent laser photoplethysmography (Stiffness index (SI, m/s), phase shift (PS m/s) occlusion index (OI), nail fold videocapillaroscopy (capillary density at rest, after reactive hyperemia and venous occlusion (CDr, CDrh, CDvo, respectively, cap/mm2) and applanation tonometry (central aortic systolic pressure (CASP), (radial augmentation index (RAI)) in order to assess structural and functional characteristics of blood vessels.

Results
In six months after EECP, significant improvement in patient's condition was found. T6MW distance (212±32 vs 251±29 m, p&lt;0.05), QL MSQ (20.1±6.2 vs 41,6±7,1, p&lt;0.05) and LVEF (40.9±7,6% vs 45.2±10.1%, p&lt;0.05) increased significantly.
Stiffness of large vessels was found to be decreased. CASP, RAI and SI decreased significantly, (CASP: 131±15.8 vs 129±14.8 mmHg, p&lt;0.05), (RAI: 97.2±25.1 vs 97±21.6%, p&lt;0.05), (SI: 8.9±1.5 vs 8.8±,1.6 m/s, p&lt;0.05), Functional characteristics of large blood vessels significantly improved (PS (5.6±1.2 vs 6.8±1.4 m/s, p&lt;0.05).
Microcirculation - Reflection index (106.7 vs 95.3%, p&lt;0.05) and OI (1.5±0.3 vs 1.66±0.26, p&lt;0.05) for all. Increase CDrest (44±12.2–44.6±11.5 capillaries, p&gt;0.05), in samples with CDrh (45±14 vs 57±16 capillaries, p&lt;0.05) and CDvo (55±15–56 vs 4±14.2 capillaries, p&lt;0.05).

Conclusion
ECCP treatment of patients with stable CAD, in addition to optimal drug therapy, led to an increase in load tolerance and improvement of the QL, myocardial contractile function, accompanied by improvement of the structural and functional state of large vessels and microcirculatory bed.

Funding Acknowledgement
Type of funding sources: None.