bluuebunny/crossref_metadata_2025_split huggingface dataset:
Trends, predictors and outcomes of need for hemodialysis after heart transplantation
Authors: Briasoulis A , Doulamis I , Kampaktsis P , Kuno T , Alvarez P 
Published: October 2021

Abstract

Introduction
Acute renal failure is not uncommon immediately after heart transplantation (HT) and it is related to pre-existing cardiorenal syndrome, perioperative parameters, early post-operative course and initiation of calcineurin inhibitor therapy. We sought to investigate the trends, predictors and outcomes of renal failure requiring hemodialysis after HT.

Methods
Adult HT recipients were identified in the United Network for Organ Sharing (UNOS) registry between 2009 and 2020. Patients were grouped according to the requirement for hemodialysis in the post-operative period after HT. Accounting for re-transplantation, Fine and Gray's test compared cumulative incidences of all-cause mortality between groups. Univariate and multivariate analysis were performed using the competing risk model.

Results
A total of 26,634 patients were included in the study including 3,148 HT that required hemodialysis. Overall, the incidence of post HT dialysis increased during the study period (p&lt;0.001, Figure 1). Patients on hemodialysis had significantly higher serum creatinine at the time of HT (1.51 vs. 1.21 mg/dl, p&lt;0.001). Multivariable logistic regression analysis identified longer ischemic time (p&lt;0.001), serum creatinine at HT higher than 1.2 mg/dl, higher calculated panel reactive antibody (%) (p=0.003), prior cardiac surgery (p&lt;0.001), older donor age (p&lt;0.001), higher recipient body mass index (p&lt;0.001), mechanical ventilation at HT (p&lt;0.001), support with extracorporeal membrane oxygenation (p&lt;0.001) as independent predictors of hemodialysis need after HT. After adjusting for described confounders patients on hemodialysis had higher risk of 30-day (odds ratio 1.44, 95% CI 1.33–1.56, p&lt;0.001) and all-cause mortality (sub-hazard ratio = 5.4, 95% CI 4.81–6.03, p&lt;0.001)

Conclusion
Over 1 in 10 HT recipients require hemodialysis after HT. Need for hemodialysis is associated with worse 30-day and long-term mortality after HT.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Heart transplantation and antibody-mediated rejection: role of myocardial strain as an early marker of cardiac dysfunction in patients with anti-HLA antibody
Authors: Sciaccaluga C , Natali B.M , Mandoli G.E , Sisti N , Righini F.M , Menci D , D'Errico A , Benfari G , D'Ascenzi F , Cavigli L , Focardi M , Valente S , Bernazzali S , Maccherini M , Cameli M 
Published: October 2021

Abstract

Background
Antibody-mediated rejection of the transplanted heart is still currently diagnosed by endomyocardial biopsy whereas clinical elements, anti-Human Leukocite Antigens (HLA) antibody and graft dysfunction represents supplementary components.

Purpose
The aim of the study was to identify though a non-invasive imaging technique, such as advanced transthoracic echocardiography, early signs of altered cardiac function in patients with anti-HLA antibodies and no histological signs of antibody-mediated rejection.

Methods
The study population included 117 heart transplanted patients, in whom both acute and chronic rejection was excluded. They were divided into two groups “HLA+`' (45 patients) and “HLA−” (72 patients), based on the presence and the absence of circulating anti-HLA antibodies, respectively. The echocardiographic exam was performed within one week from the biopsy, including Speckle Tracking analysis.

Results
Deceleration Time of E wave was the strongest traditional echocardiographic parameter which correlated with circulating anti-HLA antibodies (165±39,5 vs 196,5±25; p&lt;0.001). Regarding strain analysis, both left ventricular global longitudinal strain (−16,1±3,4 vs −19,8±2,0; p&lt;0.001) and right ventricular strain (−17,2±0,7 vs −20,6±0,5; p=0.0002) differed significantly between the two subgroups (Figure 1). On the other hand, neither peak atrial longitudinal strain nor peak atrial contraction strain showed a significant correlation with anti-HLA antibodies.

Conclusion
The presence of circulating anti-HLA antibodies seems to be correlated with a mild cardiac dysfunction, even in the absence of antibody-mediated rejection. This subtle dysfunction is not completely detectable by standard echocardiographic parameters, whereas strain analysis has showed promising results since it revealed more clearly an impaired function of both ventricles in heart transplanted HLA+ patients, with potentially important clinical repercussion.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Outcomes of diabetic patients with end-stage heart failure listed for heart transplantation: a propensity-matched analysis
Authors: Akintoye E , Alvarez P , Briasoulis A 
Published: October 2021

Abstract

Background
There are on-going concerns about offering heart transplants to patients with diabetes due to the risk of poor outcomes. We investigated the current trends and outcomes of patients listed for heart transplants in the U.S. and provided a method for risk-stratification.

Methods
Using data from the United Network for Organ Sharing (UNOS), we identified heart failure patients listed for heart transplants between 2010 and 2019. Diabetic patients were propensity-matched with non-diabetes, and waitlist mortality as well as post-transplant graft survival were compared between the two matched groups. Further risk-stratification of the diabetic cohort was done based on the risk factors that independently predict the risk of graft failure.

Results
28,928 adult patients (30% diabetic) with end-stage heart failure were added to the waitlist over the study period. In the propensity-matched cohort, waitlist mortality was higher with diabetics compared to non-diabetics: 19.3 vs 17.1 deaths per 100 person-years, respectively, (HR=1.13 (95% CI=1.04–1.22, p=0.002). Over the study period, 5739 diabetics (mean age 57.6 years, 21.9% female) were transplanted. A total of 1308 (23.3%) and 1143 (20.4%) graft failures occurred in diabetic and non-diabetic recipients, respectively. Compared to non-diabetics, diabetics experienced worse graft survival (HR=1.17, 95% CI=1.08–1.26, p&lt;0.001). We developed a risk score based on the 12 risk factors/markers that independently predict worse graft survival and a risk score of 4 reasonably differentiates between low and high-risk diabetics. Low risk diabetics (score≤4) had similar graft survival as non-diabetics with 1- and 5-year survival of 92.7% and 80.5%, respectively, (HR=0.91, 95% CI=0.82–1.01, p=0.06). On the other hand, high-risk diabetics had worse graft survival compared to non-diabetics (HR=1.52, 95% CI=1.38–1.67, P&lt;0.001) with 1- and 5-year graft survival of 86.8% and 69.8%, respectively.

Conclusion
Diabetic patients with end-stage heart failure listed for heart transplantation experience higher waitlist mortality and worse post-transplant graft survival compared to non-diabetics. However, a simple risk score can be used for further risk-stratification in these patients to maximize survival benefit.

Funding Acknowledgement
Type of funding sources: None.
Hydration status, BMI and troponin as factors of an impaired exercise tolerance in women over 40 with arterial hypertension
Authors: Bielecka-Dabrowa A.M , Gryglewska K , Sakowicz A , Janikowski K , Maciejewski M , Banach M 
Published: October 2021

Abstract

Purpose
The aim was to identify factors influencing maximal oxygen uptake (VO2max) and early identification of hypertensive women at risk of heart failure (HF).

Methods
The 185 consecutive females with controlled hypertension were divided according VO2max quartiles. The patients underwent echocardiography, non-invasive body mass analysis, spiroergometry and hemodynamic parameters. Regression analyses determined predictors of the lowest VO2max (quartile 1: VO2max &lt;17 ml/kg/min).

Results
Females with the worst oxygen consumption had significantly higher level of high sensitive cardiac Troponin T (hs-cTnT) [p=0.001], higher values of the left atrial (LA) volume, late diastolic mitral annulus velocity (A'), ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion (E/E') [p=0.0003, p=0.02, p=0.04; respectively] and lower E' [p=0.001] compared to controls. Women with the worst exercise capacity had higher body mass index (BMI) and fat content (kg and %) [p&lt;0.0001], higher fat free mass (FFM) (kg) [p&lt;0.0001], higher total body water content (TBW) [p=0.0002] as well as extracellular body water content (ECW) [p&lt;0.0001] and intracellular body water content (ICW) [p=0.005], ECW/TBW x 100% [p&lt;0.0001] and metabolic age [p&lt;0.0001] compared to counterparts. In a multiple logistic regression model independently associated with VO2max were: ECW/TBW x 100% (OR 4.45, 95% CI: 1.77–11.21; p=0.002) Figure 1, BMI (OR 7.11, 95% CI: 2.01–25.11; p=0.002) Figure 2 and hs-cTnT level (OR 2.69, 95% CI: 1.23–5.91; p=0.013).

Conclusions
High-sensitivity cardiac troponin may serve as early biomarker of heart failure in hypertensive women. Hydration status should be considered in overall hypertensive women care. There is an importance of body mass compartments analysis in early identification of hypertensive females at risk of heart failure.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Project is financed by the Polish National Agency for Academic Exchange under the Foreign Promotion Programme. Figure 1Figure 2
Peritoneal dialysis as a therapeutic solution in elderly patients with cardiorenal syndrome and heart failure: a case-series report
Authors: Chrysohoou C , Magkas N , Kapota A , Bougatsos G , Kopelias J , Bliouras N , Petras D , Tsioufis K 
Published: October 2021

Abstract

Background
The aim of this work was to evaluate the impact of peritoneal dialysis (PD) on venous congestion, right ventricle function, systolic arterial pulmonary pressure and clinical functional status in elderly patients with cardiorenal syndrome (CRS) and chronic heart failure (HF).

Methods
A case series of 21 (17 males, 70±11 years) consecutive pts with diuretic-resistance heart failure and right ventricular dysfunction (median renal failure duration (RF) 60 months, range 13–287 months, mean ejection fraction 36±11%) having been engaged in PD (median of 12.5 months, range 2–28); 77% of the pts were under Automated Peritoneal Dialysis (APD), whereas the rest were under Continuous Ambulatory PD (CAPD). Patients' Pulmonary Artery Systolic Pressure (PASP), Central Venus Pressure (CVP) – through compression sonography – and body weight were evaluated in 6 intermediate clinical visits.

Results
During the follow-up period, the mortality rate was 8 deaths out of 21 pts (38%) (or 3 deaths/100 person-months).A significant reduction by 29.9% in PASP levels (p=0.013)and by 42% in CVP levels (p&lt;0.001), and in right ventricular function was observed; whereas pts weight increased by 3.7% (p=0.001). NYHA class improved in 12 pts; whereas, in the rest pts remained constant (p=0.046). In 8 pts complications were reported (mainly presence of staphylococcus. aureus).

Conclusion
PD seems to confer a substantial benefit in clinical status, in line with improvement in venous congestion and right ventricle systolic pressure among elderly HF patients with CRS.

Funding Acknowledgement
Type of funding sources: None.
Long-term evolution of estimated glomerular filtration rate in heart failure
Authors: Codina Verdaguer P , Buchaca D , Spitaleri G , Domingo M , Santiago-Vacas E , Cediel G , Zamora E , Santesmases J , Troya M.I , Escabia C , Gonzalez B , Rivas C , Nunez J , Lupon J , Bayes-Genis A 
Published: October 2021

Abstract

Background
Limited data are available on the very long-term trajectory of glomerular filtration rate (GFR) in patients with chronic heart failure (HF).

Purpose
To assess the GFR dynamics estimated by CKD-EPI in a real-life cohort of HF patients over a 14-year follow-up.

Methods
In a prospective observational registry of real-life HF outpatients, estimated GFR (eGFR) was calculated by CKD-EPI at baseline and on a structured schedule every 3 months up to 14 years. We included in the analysis only eGFR values that were assessed at scheduled visits, discarding urgent renal function assessments. Loess (locally weighted error sum of squares) curves were plotted for the whole cohort and subgroups according to vital status up to 14 years of follow-up. Loess curves are useful to observe a trend or relationship on nonlinear data observed over time.

Results
2423 patients were consecutively included from August 2001 to December 2018. Mean age was 67.0±12.7 years, 28,8% were women and 71.1% had HF with reduced ejection fraction (EF&lt;40%). Out of 37360 eGFR values, 25458 were included in the analysis with a median of 8 values per patient [IQR 4–15] and a range between 1 and 47.
Significant changes occurred along the whole trajectory. An initial decline in eGFR was observed during the first three years of follow-up. Subsequently, there was an upward trend during the following five years and after that period a progressive decline was seen until the end of follow-up (Figure 1). In the sub-group of patients who died during follow-up the eGFR slope showed a persistent decline over time of ∼1ml/min/1.73m2 per year. On the contrary, patients who survived to follow-up maintained a stable eGFR (Figure 2).

Conclusions
The eGFR long-term trajectory in patients with chronic HF showed a snaky pattern with an early decrease, mid-term improvement and late progressive decline. Patients who died during follow-up presented a progressive decline from the beginning.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Long-term evolution of eGFRFigure 2. eGFR evolution according to vital status
Derivation of an electronic frailty index for short-term mortality in heart failure: a machine learning approach
Authors: Ju C , Zhou J , Lee S , Tan M S , Liu T , Wu W K K , Jeevaratnam K , Chan E W Y , Wong I C K , Wei L , Zhang Q , Tse G 
Published: October 2021

Abstract

Objective
Frailty may be found in heart failure patients especially in the elderly and is associated with a poor prognosis. However, assessment of frailty status is time-consuming and the electronic frailty indices developed using health records have served as useful surrogates. We hypothesized that an electronic frailty index developed using machine learning can improve short-term mortality prediction in patients with heart failure.

Methods
This was a retrospective observational study included patients admitted to nine public hospitals for heart failure from Hong Kong between 2013 and 2017. Age, sex, variables in the modified frailty index, Deyo's Charlson comorbidity index (≥2), neutrophil-to-lymphocyte ratio (NLR) and prognostic nutritional index (PNI) were analyzed. Gradient boosting, which is a supervised sequential ensemble learning algorithm with weak prediction submodels (typically decision trees), was applied to predict mortality. Variables were ranked in the order of importance with a total score of 100 and used to build the predictive models. Comparisons were made with decision tree and multivariate logistic regression.

Results
A total of 8893 patients (median: age 81, Q1-Q3: 71–87 years old) were included, in whom 9% had 30-day mortality and 17% had 90-day mortality. PNI, age and NLR were the most important variables predicting 30-day mortality (importance score: 37.4, 32.1, 20.5, respectively) and 90-day mortality (importance score: 35.3, 36.3, 14.6, respectively). Gradient boosting significantly outperformed decision tree and multivariate logistic regression (area under the curve: 0.90, 0.86 and 0.86 for 30-day mortality; 0.92, 0.89 and 0.86 for 90-day mortality).

Conclusions
The electronic frailty index based on comorbidities, inflammation and nutrition information can readily predict mortality outcomes. Their predictive performances were significantly improved by gradient boosting techniques.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of sarcopenia and malnutrition in patients admitted for acute decompensated heart failure with reduced or preserved left ventricular ejection fraction
Authors: Ito S , Yamada T , Watanabe T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Kayama K , Kawahira M , Ueda K , Fukunami M 
Published: October 2021

Abstract

Background
Sarcopenia and malnutrition are associated with poor clinical outcome in patients with chronic heart failure. However, there is little information available on the prognostic significance of the combination of sarcopenia and malnutrition in patients with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).

Methods
We prospectively studied 543 consecutive ADHF patients who survived to discharge (HFrEF [LVEF &lt;45%] n=245 and HFpEF [LVEF≥45%] n=298). At the discharge, sarcopenia and malnutrition was evaluated by free-fat mass index (FFMI) and geriatric nutrition risk index (GNRI), respectively. FFMI was calculated as follows: FFMI = (7.38 + 0.02908 × urinary creatinine [mg/day])/ (height in meter)2. Sarcopenia was defined as FFMI &lt;17 kg/m2 in men and &lt;15 kg/m2 in women. GNRI was calculated as follows: 14.89 × serum albumin (g/dl) + 41.7 × BMI/22, and malnutrition was defined as GNRI&lt;92. The endpoint was all-cause death.

Results
During a follow-up period of 2.8±1.4 years, 161 patients had all-cause death. Multivariate Cox analysis showed that both FFMI and GNRI were independently associated with all-cause death in both HFrEF (p=0.0064 and p&lt;0.0001, respectively) and HFpEF patients (p=0.0140 and p=0.0007, respectively) after adjustment for relevant baseline clinical and study characteristics. In HFrEF, patients with both sarcopenia and malnutrition had a significantly higher risk of the total mortality than those with either or none of them. On the other hand, in HFpEF, patients with both and either sarcopenia or malnutrition had a significantly higher risk of the total mortality than those with none of them, while there was no significant difference in the risk between both and either sarcopenia or malnutrition.

Conclusions
Sarcopenia or malnutrition at discharge was associated with all-cause death even in ADHF patients, irrespective of reduced or preserved LVEF. The combination of sarcopenia and malnutrition could provide prognostic information in ADHF patients with reduced LVEF.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Temporal changes in resting heart rate before and after heart failure decompensation in a large real-world population of patients with reduced ejection fraction
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 nighttime heart rate, as a surrogate of resting heart rate, 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 related diagnostics were included for this study. The device computes nighttime heart rate as the average heart rate between midnight and 4 am. 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 night heart rate in the 60 days pre and post HF events were compared between HF events with and without readmission within 60 days as well as with periods with no HF events.

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 night heart rate pre and post HF events with and without readmission and in follow-ups 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. A 3-day average night heart rate increased by &gt;3 bpm in a large proportion of patients in the 30-day period before HF event compared to 30-day periods with no events (28% vs 16%; Odds Ratio: 2.08; p&lt;0.001). Patients who were readmitted for HF have higher average NHR before and after admission compared to patients who are not readmitted. In patients who were not readmitted, the night heart rate recovers to baseline levels on an average within 10 days post discharge.

Conclusions
In a large real-world population of patients with ICD/CRTD devices, the average night heart rate increases before HF events. Patients who are readmitted are more likely to have higher night heart rate after discharge.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Medtronic Plc
Discharge FGF23 levels predicts one year outcome in patients admitted with acute heart failure
Authors: Aimo A , Vergaro G , Taurino E , Del Franco A , Fabiani I , Prontera C , Masotti S , Musetti V , Emdin M , Passino C 
Published: October 2021

Abstract

Background
Patients with acute heart failure (AHF) show high levels of fibroblast growth factor-23 (FGF23) on admission. We examined if plasma FGF23 changes during an episode of AHF, and if FGF23 holds prognostic significance in this setting.

Methods
Consecutive AHF patients were enrolled. Blood samples were collected on admission and at discharge. Patients were then followed for all-cause death or HF hospitalization.

Results
Patients (n=125; median age 76 years [interquartile interval 71–83], 63% men, left ventricular ejection fraction 35% [25–56%]) had median admission FGF23 70 ng/L (47–100), N-terminal pro-B-type natriuretic peptide (NT-proBNP) 5,844 ng/L (2,503–10,468), high-sensitivity troponin T (hs-TnT) 40 ng/L (25–72), and soluble suppression of tumorigenesis-2 (sST2) 26 ng/mL (17–37). While other biomarkers decreased, FGF23 increased by 15% from admission to discharge (p=0.033), with a significant correlation with percent changes in estimated glomerular filtration rate (rho=0.306, p=0.001). Over a 12-month follow-up, 64 patients (51%) experienced the endpoint. They were more often men, older, with higher systolic pulmonary artery pressure (sPAP), higher NT-proBNP, hs-TnT and discharge FGF23. The best FGF23 cut-off at discharge from receiver operating characteristics analysis was 78 ng/L. Both discharge FGF23 and the 78 ng/L cut-off independently predicted outcome in models including gender, sPAP, age, and 1) admission NT-proBNP, 2) discharge NT-proBNP, 3) admission NT-proBNP and hs-TnT, 4) discharge NT-proBNP and hs-TnT. The 78 ng/L cut-off also refined risk reclassification.

Conclusions
During an AHF episode, FGF23 increases from admission to discharge, and patients with higher discharge FGF23 have a higher risk of worse outcome.

Funding Acknowledgement
Type of funding sources: None.