bluuebunny/crossref_metadata_2025_split huggingface dataset:
Predictors and prognosis of RV function in pulmonary hypertension due to heart failure with reduced ejection fraction
Authors: Schmeisser A , Rauwolf T.H , Groscheck T , Fischbach K , Luani B , Kropf S , Tanev I , Hansen M , Meissler S , Schaefer K , Steendijk P , Braun-Dullaeus R 
Published: October 2021

Abstract

Background and aims
Failure of right ventricular (RV) function worsens outcome in pulmonary hypertension (PH). The adaptation of RV contractility to afterload, the RV-pulmonary artery (PA) coupling, is defined by the ratio of RV end-systolic to PA elastances (Ees/Ea). Using pressure volume loop (PV-L) technique we aimed to identify an Ees/Ea cutoff predictive for overall survival and to assess hemodynamic and morphologic conditions for adapted RV function in secondary PH due to Heart Failure with Reduced Ejection Fraction (HFREF).

Methods
This post hoc analysis is based on 112 patients of the prospective Magdeburger Resynchronization Responder Trial. All patients underwent right and left heart echocardiography, and a baseline PV-L and RV catheter measurement. A subgroup of patients (n=50) without a pre-implanted cardiac device underwent MRI at baseline.

Results
The analysis revealed that 0.68 is an optimal Ees/Ea cutoff (area under the curve: 0.697, p&lt;0.001) predictive for overall survival (median follow up = 4.7 years, Ees/Ea ≥0.68 vs. &lt;0.68, log-rank 8.9, p=0.003. In patients with PH (n=76, 68%) Multivariate Cox-regression demonstrated the independent prognostic value of RV-Ees/Ea in PH patients (HR 0.2, p&lt;0.038). Patients without PH (n=36, 32%) and those with PH but RV-Ees/Ea ≥0.68 showed comparable RV-Ees/Ea ratios (0.88 vs. 0.9, p=0.39), RV size/function, and survival. In contrast, secondary PH with RV-PA coupling ratio Ees/Ea &lt;0.68 corresponded extremely close to cut-off values that define RV dilatation/remodeling (RVEDV &gt;160ml, RV-mass/volume-ratio &lt;0.37 g/ml) and dysfunction (RVEF &lt;38%, TAPSE &lt;16mm, FAC &lt;42%, and stroke-volume/end-systolic volume ratio &lt;0.59) and is associated with a dramatically increased short and medium-term all-cause mortality. Independent predictors of prognostically unfavorable RV-PA coupling (Ees/Ea &lt;0.68) in secondary PH were a preexistent dilated RV (end-diastolic volume &gt;171ml, odds ratio, OR 0.96, p=0.021), high pulsatile load (PA compliance &lt;2.3 ml/mmHg, OR 8.6, p=0.003), and advanced systolic left heart failure (left ventricular (LV) ejection fraction &lt;30%, OR 1.23, p=0.028).

Conclusions
The RV-PA coupling ratio Ees/Ea predicts overall survival in PH due to HFREF and is mainly affected by pulsatile load, RV remodeling and LV dysfunction. Prognostically favorable coupling (RV-Ees/Ea ≥0.68) in PH was associated with preserved RV size/function and mid-term survival, comparable to HFREF without PH.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Boston Scientific
Reverse remodelling criteria to predict cardiovascular death in heart failure with reduced or mid-range ejection fraction
Authors: Aimo A , Fabiani I , Vergaro G , Arzilli C , Chubuchny V , Pasanisi E.M , Petersen C , Poggianti E , Taddei C , Bayes-Genis A , Lupon J , Giannoni A , Georgiopoulos G , Passino C , Emdin M 
Published: October 2021

Abstract

Aims
Reverse remodelling (RR) is the recovery from left ventricle (LV) dilatation and dysfunction. There are no established definitions of RR. We sought to identify RR criteria that better predicted cardiovascular death.

Methods and results
Forty-two studies used 25 criteria to define RR, most commonly (n=12) as LV end-systolic volume (LVESV) reduction ≥15%. We evaluated 927 patients with LV ejection fraction (LVEF) &lt;50% undergoing 2 echocardiograms within 12±2 months. Over a median 2.8-year follow-up after the second echocardiogram (1.3–4.9), 123 cardiovascular deaths occurred (13%). Model 1 included age, LVEF, N-terminal pro-B-type natriuretic peptide (NT-proBNP), ischaemic aetiology, cardiac resynchronization therapy (CRT), estimated glomerular filtration rate (eGFR), New York Heart Association (NYHA), and LVESV index (LVESVi), and Model 2 the validated 3C-HF score. Two RR criteria proved particularly effective in risk reclassification over Model 1 and Model 2: LVEF increase ≥1 category (severe [LVEF ≤30%], moderate [LVEF 31–40%], mild LV dysfunction [LVEF 41–55%] and normal LV function [LVEF ≥56%]), and LVEF increase &gt;10 U. The same 2 criteria yielded independent prognostic significance and improved reclassification also in patients with LVEF &lt;40% or LVEF ≤35%. LVEF increase ≥1 category and LVEF increase &gt;10 U displayed a stronger prognostic value than LVESV reduction ≥15%, both in the whole population and the subsets with LVEF &lt;40% or ≤35%.

Funding Acknowledgement
Type of funding sources: None.
The representativeness of VICTORIA and GALACTIC-HF trials in a contemporary cohort of patients with heart failure with reduced ejection fraction
Authors: Oliveira Campinas A , Campos S.C , 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
New therapies for heart failure with reduced ejection fraction (HFrEF) have been recently developed. It is still unclear the proportion of patients of clinical practice that will benefit from them. We aimed to examine the representativeness of the VICTORIA and GALACTIC-HF trials among a contemporary cohort of HFrEF patients followed at an HF outpatient clinic.

Methods
We performed a retrospective, cross-sectional, single-center study of 100 consecutive HFrEF patients from our HF outpatient clinic (January-June 2020). VICTORIA eligibility criteria were an LVEF &lt;45%; NT-proBNP ≥1000 pg/mL if sinus rhythm (SR) or ≥1600 pg/mL if atrial fibrillation (Afib); and prior hospitalization in the last 6 months or IV diuretic therapy in the last 3 months. GALACTIC-HF eligibility criteria were an LVEF &lt;35%, hospitalization or emergency room visit in the last 12 months; NT-proBNP &gt;400 ng/mL if SR or ≥1200 pg/mL if Afib or atrial flutter.

Results
The mean age of our patients was 62±12 years and only 24% were female. The etiology of HF was ischemic in 42% of the patients, 86% of patients 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]. Regarding treatment, 92% of patients were on betablockers (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 proportion of patients meeting VICTORIA and GALACTIC-HF eligibility criteria was 11% and 21%, respectively. But excluding the criteria of recent hospitalization the representativeness of the VICTORIA trial increased to 28% and the GALACTIC-HF to 44%. The patients that met VICTORIA eligibility criteria were older (60±11 y vs 10±12 y; p=0.006), had worse functional class (NYHA III-IV: 18% vs 3%; p=0.03), were less likely to be treated with an MRA (55% vs 85%; p=0.013) and an iSGLT2 (0% vs 34%; p=0.02). Those that met GALACTIC-HF eligibility criteria had a lower LVEF (31±3% vs 35±6%; p=0.01), were less likely to be treated with an iSGLT2 (35% vs 10%; p=0.02) and more likely to be treated with a loop diuretic (86% vs 65%; p=0.06).

Conclusions
In a contemporary optimally treated HFrEF cohort only a small proportion of patients met the eligibility criteria used in VICTORIA and GALACTIC-HF trials, which identified older patients with more advanced disease.

Funding Acknowledgement
Type of funding sources: None.
Evaluation of right ventricular function in acute pulmonary embolism by 3D ejection fraction and longitudinal strain echocardiography in acute phase and follow-up
Authors: Ramos Lopez N , Mahia Casado P.M.C , Islas Ramirez F.I.R , Ferrera C.F.D , Enriquez Vazquez D.E.V , Luque Diaz T.L.D , Noriega Sanz F.N.S , Abelaira Freire J.A.F , Perez Serrano M.P.S , Higueras Nafria J.H.N , Galvan Herraez L.G.H , Pedrajas J.M.P , Fernandez Ortiz A.F.O , Salinas Sanguino P.S.S , Macaya C.M.M 
Published: October 2021

Abstract

Background
Assessment of right ventricular (RV) function by transthoracic echocardiography (TTE) in acute pulmonary embolism (PE) has an essential role to severity stratification. However, there is no reliable information on RV function about the clinical utility of advanced TTE parameters in follow-up.

Purpose
We aimed to assess the clinical utility of 3D RV ejection fraction (3DEF) and free wall longitudinal strain (FWLS) compared to conventional parameters in evaluating RV function in patients with acute PE at time of diagnosis and after follow-up and the relation with adverse outcomes.

Methods
We prospectively recruited 86 patients with intermediate-high and high-risk bilateral PE from 2018 to 2020 in our centre. Patients underwent TTE during admission and at 6 to 12 months follow-up that included conventional RV parameters (pulsed Doppler S wave (S'), TAPSE, and fractional area change (FAC)). 3DEF and FWLS were obtained as well. Normal values were stablished according to European guidelines.

Results
Mean age was 63.7±16.5 years, 58% males. Reperfusion treatment was performed in a 26,8%. In-hospital mortality was 4,7% (3 patients in the acute phase of PE and 1 due to rePE. The median follow-up was 1.3 years (IQR 1–2.5). 9 patients died (2 due to PE, 3 due to respiratory failure and 5 due to cancer). Patients with adverse events had a greater severity in PESI scale and worse RV function assessed by 3DEF and 3D volumes. There were no significant differences between groups in FAC, S' and TAPSE (Table 1).
Baseline echocardiographic parameters were analyzed in the acute phase during admission and at 6–12 month follow-up (Table 2). There was a significant improvement in conventional parameters (TAPSE and FAC) and a reversal of FWLS values (P=0,01) at follow-up. 3DEF improved, but was not statistically significant (p=0,06). There was a greater reversal in end-systolic volume compared to end-diastolic volume.

Conclusion
Advanced RV function assessment by 3DEF and FWLS is useful in the acute phase and follow-up. FWLS showed and early normalization after PE resolution, whereas 3DEF improved but remained pathological at 6–12 months follow-up.

Funding Acknowledgement
Type of funding sources: None. Table 1Table 2
Prediction of major adverse cardiovascular events in heart failure patients using face recognition: rationale and study design of the CARDIOMIRROR trial
Authors: Jimenez-Blanco Bravo M , Alvarez Garcia J , Del Prado Diaz S , Esteban Fernandez A , Cordero Pereda D , Zamorano Gomez J.L 
Published: October 2021

Abstract

Background
Heart failure (HF) is a growing epidemic, currently affecting more than 26 million people around the globe. Although numerous prognostic markers of death and HF hospitalization have been identified, their clinical applicability is limited and precise risk stratification in HF remains challenging.

Aim
The aim of this project is to develop a software (“intelligent mirror” or CARDIOMIRROR) with the ability to detect significant facial changes in patients with heart failure with reduced ejection fraction (HFrEF). Our main hypothesis is that facial changes will correlate with major adverse cardiovascular events (MACE) in these patients.

Methods
For this purpose, we have designed an observational, prospective, multicenter pilot study, which will include 100 adult ambulatory patients with HFrEF, in NYHA class ≥ II and, at least, one hospitalization due to decompensated HF in the past 12 months or BNP ≥500 pg/ml.
The primary end-point is to analyze the morphological and colorimetric facial changes that occur in patients with HFrEF, and to determine the association between these changes and the presence of MACE at 1 year, including episodes of acute decompensated HF, myocardial infarction, stroke or death.
Secondary end-points include the correlation between facial changes and natriuretic peptides, LVEF, quality of life, NYHA class and daily physical activity.
All patients will be given a Smartphone, and they will be required to take a daily 7-seconds video of their face during 12 months of follow-up. This daily video will be sent to an automatic server for its morphologic and colorimetric analysis by experienced engineers (Figure 1), employing Deep Learning, virtual and augmented Reality, Internet of Things and Data Analytics.

Conclusion
The CARDIOMIRROR study represents a revolutionary strategy, as it involves shifting from a traditional “reactive” model to an innovative “predictive” model, in which medical care anticipates the event in question. Its results could potentially change the conventional approach to HF patients.

Funding Acknowledgement
Type of funding sources: None. Morphologic (left), colorimetric (right)
Linking extracellular inhibitors of Wnt/beta-catenin signaling to carotid intima-media thickness in heart failure with reduced ejection fraction
Authors: Szabo T.M , Fehervari L , Nagy E.E , Frigy A 
Published: October 2021

Abstract

Background
The Wnt/β-catenin signaling pathway plays an important role in endothelial inflammation, vascular calcification, contributing to atherosclerosis development and progression. Sclerostin and Dickkopf-1 (DKK-1) are soluble extracellular canonical Wnt signaling inhibitors frequently associated with atherosclerotic disease.

Purpose
We investigated the possible association between carotid intima-media thickness (cIMT) and circulating levels of sclerostin and DKK-1 in patients with heart failure with reduced ejection fraction (HFrEF).

Methods
65 patients with HFrEF were assigned to one of two groups based on cIMT measurements: 30 patients had normal cIMT, whereas 35 patients showed pathological cIMT. CIMT was assessed by vascular ultrasonography, and values above 0.9 mm were considered abnormal. Serum sclerostin and DKK-1 levels were measured using commercially available ELISA kits. Unpaired t-test and Mann-Whitney test were used for statistical analysis (p&lt;0.05 was considered statistically significant).

Results
Patients belonging to the group with abnormal cIMT were older (70±9 years vs. 57±12 years, p&lt;0.0001), had higher systolic blood pressure (123±16 mm Hg vs. 112±15 mm Hg, p=0.005), and had more often type 2 diabetes mellitus (40.00% vs. 13.33%, p=0.017). Sclerostin levels were significantly higher in the abnormal cIMT population (537.91±816.69 pg/mL vs. 276.37±173.21 pg/mL, p=0.017), whereas serum DKK-1 concentrations did not differ significantly (398.34±218.73 pg/mL vs. 352.35±188.08 pg/mL, p=0.498). The two groups had similar C-reactive protein levels (1.78±2.77 mg/dL vs. 1.88±2.77 mg/dL, p=0.200), estimated glomerular filtration rates (73.60±22.32 mL/min/1.73m2 vs. 66.25±23.69 mL/min/1.73m2, p=0.254) and body mass index (27.58±4.95 kg/m2 vs. 26.65±5.75 kg/m2, p=0.490).

Conclusion
Patients with HFrEF and increased cIMT had elevated levels of serum sclerostin. DKK-1 levels did not increase with the progression of cIMT. Further studies with large sample size are needed to establish the involvement of these proteins in vascular calcification and atherosclerosis in the setting of HFrEF.

Funding Acknowledgement
Type of funding sources: None.
The value of GRACE risk score for predicting mortality in heart failure patients admitted with non-ST elevation acute coronary syndrome
Authors: Bouzas Cruz N , Cordero A , Alvarez-Alvarez B , Bertomeu-Gonzalez V , Gonzalez-Ferrero T , Zuazola P , Garcia-Rodeja F , Martinon-Martinez J , Jimenez-Ramos V , Gomez-Otero I , Diaz-Louzao C , Gude-Sampedro F , Gonzalez-Juanatey J.R 
Published: October 2021

Abstract

Background
Acute coronary syndrome (ACS) in heart failure (HF) patients has not been well studied yet.

Purpose
The main aims of this study were to compare the characteristics and outcomes of Non-ST elevation ACS (NSTACS) in patients with and without prior HF, and to assess the GRACE risk score performance for risk stratification in both groups.

Methods
All consecutive patients (n=5661) admitted due to a NSTACS from November'2003 to November'2017 in two Spanish hospitals were retrospectively analysed. Patients were divided according to prior HF. As GRACE score predicts mortality in 6 months, logistic regression models were used to predict mortality in both groups. The different aspects of model performance were studied, including calibration and discrimination.

Results
Killip class, GRACE and CRUSADE scores were higher in HF-patients compared to patients without prior HF. Also, HF-patients had more complications (major bleeding, worsening HF, acute kidney injury) and higher mortality. Discrimination capacity of GRACE score to predict mortality at 6 months was slightly higher in non-HF patients (AUC 83.9% [81.6–86.2]) than in HF-patients [AUC 77.0% [70.1–83.8]) (Figure 1). The risk score calibration was acceptable for both groups [Brier scores were 0.139 (c-AUC 0,77) for HF-patients, and 0.046 (c-AUC 0.839) for non-HF patients]. Finally, HF-patients with lower GRACE scores had a higher predicted mortality than non-HF patients (Table 1).

Conclusions
We showed the potential utility of GRACE risk score in HF-patients admitted with NSTACS, expanding the indication of GRACE risk score for HF-patients as well. In fact, GRACE risk score not only keeps its accuracy, but it is even more robust in HF-patients than in non-HF patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1Table 1
Heart failure with reduced ejection fraction: predicting exercise intolerance with echocardiography
Authors: Azul Freitas A , Ferreira C , Goncalves V , Martinho S , Almeida J , Rosa J , Campos G , Jorge E , Goncalves L 
Published: October 2021

Abstract

Introduction
Cardiopulmonary exercise testing (CPET) is routinely used in the prognostic evaluation of patients with heart failure with reduced ejection fraction (HFrEF). Left ventricular ejection fraction (LVEF) is a strong prognostic marker but have shown a bad correlation with exercise capacity. The aim of this study is to assess the relationship between echocardiographic parameters and exercise capacity in HFrEF patients.

Methods
We retrospectively assessed all patients with HFrEF submitted to CPET and echocardiography between March and September of 2019. 73 patients were eligible for analysis. ANOVA test was used to compare Weber class groups regarding echocardiographic parameters. Multivariate linear regression with a stepwise approach was used to assess independent predictors of peak VO2 uptake. ROC curves were compared to assess the best parameter to discriminate a peak VO2 &lt;10 ml/kg/min (Weber class D).

Results
Mean age was 53.4±11.7 years with 72.6% being male. Mean LVEF was 29.2±7.7% and mean peak VO2 was 13.4±3.8 ml/kg/min. Between the Weber class groups, significant differences were found in left (LV) and right ventricular (RV) longitudinal strain (P&lt;0.001 and P=0.005 respectively), in the left and right atrial reservoir strain (P=0.009 and P&lt;0.001 respectively), in pulmonary velocity acceleration time (P=0.002) and in maximal tricuspid regurgitation velocity (TRmax) (P=0.014). Left ventricular ejection fraction, tricuspid annular plane systolic excursion, and ratio E/e' were not significantly different among exercise capacity groups. Additionally, only RV longitudinal strain (r2=0.225, P=0.008) and TRmax (r2=0.073, P=0.030) were independent predictors of peak VO2. RV longitudinal strain showed the best accuracy in discriminating a Weber class of D (AUC=0.731, 95% CI: 0.613–0.848, P=0.005) with a calculated cut of −8.6% and with a negative predictive value of 95%.

Conclusion
RV longitudinal strain and TRmax seem to be the best echocardiographic predictors of exercise intolerance in patients with HFrEF. Since CPET is not widely available, these echocardiographic parameters can be clinically useful as a surrogate prognostic factor.

Funding Acknowledgement
Type of funding sources: None.
Impact of endocardial leads on the effectiveness of interventional edge-to-edge repair of tricuspid regurgitation
Authors: Goebel B , Salomon C , Abdulrahman M , Richter S , El Garhy M , Costello-Boerrigter L , Lapp H , Lauten P 
Published: October 2021

Abstract

Background
A considerable proportion of patients who are considered for percutaneous tricuspid valve edge-to-edge repair (pTVR) interventions have endocardial lead induced tricuspid regurgitation (TR). The aim of this study was to examine the impact of lead-leaflet interaction on the effectiveness of pTVR.

Methods
For each patient, the lead position within the tricuspid valve (central, commissural, or towards one of the three leaflets) and the type of lead-leaflet interaction (leaflet impingement or adhesion) were identified during thorough 2D/3D transthoracic and transesophageal echocardiography examinations. Before and after pTVR, echocardiographic data, including 3D full-volume datasets, were obtained and quantified. TR severity was graded from 1+ to 5+, based upon the effective regurgitant orifice area by the PISA method (EROAPISA) and the vena contracta area (VCA3D) as measured by multiplanar reconstruction from a 3D color Doppler loop. Maximal diastolic tricuspid annulus area from a 3D zoom image, tricuspid tenting area, and right atrial volume were quantified. Right ventricular assessments included ejection fraction (RVEF3D) and diastolic (RVVd3D) and systolic (RVVs3D) volumes.

Results
Out of 99 patients who underwent pTVR at our hospital, 38 patients had implanted cardiac devices of the following types: pacemakers (n=25, 66%), cardiac defibrillators (n=7, 18%), and biventricular pacemakers (n=6, 16%). In 24 (63%) of these device patients, TR grade was ≤2+ after pTVR. In 14 of the device patients, TR grade remained severe after intervention (Grade 3+ in 15%, grade 4+ in 11%, and Grade 5+ in 11% of the device group). In comparison, in 78% of patients without endocardial leads, only moderate TR was achieved after pTVR. Figure 1 shows the distribution of lead positions within the tricuspid valve. A relevant lead-leaflet interference (rLLI) for pTVR interventions was defined as impingement or adhesion in the target area of the coaptation device (anteroseptal or posteroseptal). Binary logistic regression analysis showed an increase risk (Odds ratio 11, R2 0.34, 95% CI 0.019–0.44, p=0.003) for a suboptimal pTVR result (TR grade &gt;2+ after intervention) in patients with rLLI. Although patients with rLLI (n=17) had significantly higher VCA3D values as compared to patients without rLLI (n=21), it was not predictive for pTVR results. Echocardiographic parameters of right ventricular and tricuspid valve dimensions showed only a trend to higher values in the group with rLLI (Table 1).

Conclusion
Endocardial lead induced TR negatively impacts the effectiveness of pTVR irrespective of the initial degree of TR.

Funding Acknowledgement
Type of funding sources: None.