bluuebunny/crossref_metadata_2025_split huggingface dataset:
VAD related infections and the risk of pump thrombosis and thromboembolic events: a EUROMACS study
Authors: Zijderhand C.F , Antonides C.F.J , Veen K.M , Schoenrath F , Gummert J , Nemec P , Merkely B , Musumeci F , Meyns B , De By T , Bogers A.J.J.C , Caliskan K 
Published: October 2021

Abstract

Background
In patients supported by a ventricular assist device (VAD) major infections are a frequently reported adverse event with increased morbidity and mortality.

Purpose
The purpose of this study was to investigate the possible association between infections and cerebrovascular accidents (CVAs) in VAD patients.

Methods
An analysis of the European Registry for Patients Assisted with Mechanical Circulatory Support (EUROMACS) was performed identifying all patients aged ≥18 years with a LVAD or BiVAD implantation. Infections were categorized as VAD-specific infections, VAD-related infections and, non-VAD infections. An extended Kaplan-Meier analysis for the risk of CVA and mortality with infection as a time-dependent covariate was performed. Furthermore, a multivariable Cox proportional hazard model was performed including 24 variables.

Results
For this analysis 3784 patients were included, with 45 patients being supported by a BiVAD and 3739 by an LVAD. The majority of patients were male (83.2%) and 60.5% had an INTERMACS patient profile 2 or 3. During follow-up, 3108 major infections were identified in 1385 (36.6%) of the patients, while 673 CVAs were identified in 545 (14.4%) of the patients. Extended Kaplan-Meier analysis with first infection as time-dependent covariate revealed a hazard ratio (HR) for CVA of 1.95 (95% CI: 1.57–2.36; p&lt;0.005) (Figure) and 1.50 (95% CI: 1.33–1.68, p&lt;0.005) for mortality. Multivariable analysis confirmed a significant association for infection and CVAs with a HR of 1.46 (95% CI: 1.29–1.64). With infections subcategorized, VAD-specific (HR: 1.57 (95% CI: 1.18–2.09)) and VAD-related infections (HR: 2.04 (95% CI: 1.44–2.89)) remained significantly associated with CVA but non-VAD infections (HR: 1.22 (95% CI: 0.92–1.64)) were not.

Conclusion
Both VAD-related and VAD-specific infections are associated with a significantly increased risk of CVA with increased risk of mortality.

Funding Acknowledgement
Type of funding sources: None. KM freedom of CVA and infection
Prediction of outcomes after heart transplantation by machine learning models
Authors: Briasoulis A , Moustakidis S , Tzani A , Doulamis I , Kampaktsis P 
Published: October 2021

Abstract

Background
Models based on traditional statistics for the prediction of outcomes after heart transplantation (HT) have moderate accuracy. We sought to develop and validate state-of-the-art machine learning (ML) models to predict mortality and acute rejection after contemporary HT.

Methods
We included adult HT recipients from the UNOS database between 2010–2018 using solely pre-transplant clinical and laboratory variables. The study cohort was randomly split in a derivation and a validation cohort with a 3:1 ratio. An effective feature selection algorithm was used to identify strong predictors of 1-year mortality and rejection in the training cohort. Results were used to train the ML models, which were then internally tested using the validation cohort. LIME explainability analysis was used for the best performing ML model. A similar subgroup analysis was performed for 3- and 5-year survival.

Results
The study cohort comprised of 18,625 patients (53±13 years, 73% males). At 1-year after cardiac transplant, there were 2,334 (12.5%) deaths. Out of a total of 134 pre-transplant variables, 39 and 27 were selected as highly predictive of 1-year mortality and acute rejection respectively, and were used in the ML models. Areas under the curve for the prediction of 1-year survival were 0.689, 0.642, 0.649, 0.637, 0.526 for the Adaboost, Logistic Regression, Decision Tree, Support Vector Machine and K-nearest neighbor models respectively, whereas the IMPACT score had an AUC of 0.569. For the prediction of 1-year acute rejection, Adaboost achieved the highest predictive performance (AUC 0.629). LIME explainability analysis identified the relative impact of the 10 strongest predictors of 1-year mortality and acute rejection. Subgroup analysis using a similar methodology for 3- and 5-year survival yielded AUC of 0.609 and 0.610 using 31 and 91 selected variables respectively.

Conclusion
ML models created and validated using a contemporary cohort of the UNOS database showed improved accuracy in predicting survival and acute rejection after HT.

Funding Acknowledgement
Type of funding sources: None.
Short and long term outcomes of cardiac amyloidosis patients listed for heart transplantation in the united states: a propensity-matched analysis
Authors: Akintoye E , Alvarez P , Briasoulis A 
Published: October 2021

Abstract

Background
Heart transplantation (HT) in cardiac amyloidosis (CA) patients has been historically controversial due to the risk of amyloid recurrence. However, recent single-center experiences suggest good outcomes in carefully selected patients. We sought to evaluate contemporary outcomes of CA patients listed for HT in the U.S. and evaluate predictors of survival

Methods
Using data from the United Network for Organ Sharing database on adult patients listed for a donor heart in the U.S. between 2010 and 2019, we identified 3 cohorts of patients, namely CA, dilated cardiomyopathy (DCM), and non-CA restrictive cardiomyopathy (RCM). Propensity-match analysis was used to compare primary outcomes of waitlist mortality and post-transplant graft survival between CA and DCM.

Results
Over the study period, 411 CA patients (mean age 62.7 years, 16.1% female) were added to the waitlist. In the propensity-matched cohorts, the rates of waitlist mortality were 33.7, 15.8, and 15.6 per 100 person-years for CA, DCM, and non-CA RCM, respectively. Compared to DCM, there was significantly higher waitlist mortality for CA (HR=1.75, 95% CI=1.16–2.65). Over the study period, 330 CA patients were transplanted with donor hearts. The 1-year graft survival rates for CA, DCM, and non-CA RCM were 89%, 92%, and 86%, respectively; and 5-year graft survival rates were 78%, 82%, and 76%, respectively. Graft survival for CA was significantly worse than DCM (HR=1.46, 1.03–2.08), and the two most significant risk factors for poor graft survival among CA patients were renal failure requiring dialysis while on the waitlist (HR=5.4, 1.6–17) and prior history of malignancy (HR=1.7, 1.0–29). CA patients with neither of the risk factor had 1- and 5-year graft survival that is comparable to those of DCM (HR=1.18, 0.81–1.74). On the other hand, CA patients with either of the risk factor had 1- and 5-year graft survival of 81% and 65%, respectively, (HR=2.33, 1.40–3.87, compared to DCM).

Conclusion
CA patients experience higher waitlist mortality and worse post-transplant graft survival compared to DCM. However, we identified two risk factors that can be used for further risk-stratification in these patients to achieve comparable graft survival as DCM.

Funding Acknowledgement
Type of funding sources: None.
Quantifying long-term improvements in exercise capacity after cardiac transplantation
Authors: Jones T.N , Chatrath N , Cole D , Dar O 
Published: October 2021

Abstract

Introduction
Cardiac transplantation (CT) is known to improve exercise capacity in patients with advanced heart failure (HF). However, it is unclear whether continued improvements occur after the initial post-operative recovery and whether baseline demographic and disease-related factors influence this improvement.

Purpose
We aimed to quantify the degree of improvement in exercise capacity over time in CT recipients and establish whether baseline characteristics influenced this improvement.

Methods
Retrospective review of the medical records of patients who underwent CT at a single centre was performed. Cardiopulmonary exercise (CPEX) testing is routinely offered pre-CT and at 3, 6, 9, 12, 24, 36 and 48 months post-CT, unless there are contraindications. Baseline demographic and clinical characteristics pre-CT were also collected.

Results
A total of 199 patients underwent CT, of which 138 (69%) were male. The mean age was 44 (SD 14.0) years and mean pre-CT body mass index (BMI) was 25.3 (SD 4.2). In 125 (63%) patients, the underlying aetiology of HF was dilated cardiomyopathy (DCM). 32 (16%) patients had a durable left ventricular assist device (LVAD) as a bridge to CT.
Pre-transplant CPEX was undertaken in 131 (66%) patients, with a mean peak VO2 of 15.5 (SD 6.2) ml/kg/min. Peak VO2 was higher in males (16.6; SD 6.7 vs 13.1; SD 4.0, p=0.002) and those under 50 years old (16.8; 7.2 vs 13.8; 3.9, p=0.005) but was not affected by the underlying aetiology (DCM vs others: 16.3, 6.6 vs 14.1, 5.1, p=0.051), the presence of an LVAD (17.3, 5.0 vs 15.1, 6.3, p=0.119) or pre-transplant obesity (14.5, 3.2 vs 15.7, 6.5, p=0.437).
Peak VO2 increased within the first year post-CT (Figure 1 and 2). Ongoing improvements were also observed beyond the 1-year time-point, although only the 3-year vs 1-year comparison remained significantly when corrected for multiple comparisons. When analysed with mixed models, time post-CT was a significant predictor of peak VO2 (p=0.001). Additionally, there was a significant interaction between peak VO2 over time with gender (p=0.038), but not with age under 50 years (p=0.244), underlying aetiology being DCM (p=0.05), a previous LVAD (p=0.664) and pre-transplant obesity (p=0.301). Post-hoc analysis showed that males had a greater mean improvement than females in peak VO2 at 1-year compared to pre-CT (7.7, SD 5.5 vs 4.8, SD 4.0 ml/kg/min).

Conclusions
These results demonstrate that exercise capacity improves up to and beyond the first year post-CT. The degree of improvement may be greater in males, although it is not influenced by age, BMI, underlying disease aetiology or the presence of an LVAD pre-CT.

Funding Acknowledgement
Type of funding sources: None.
Self-care behaviours mediate the effect of educational intervention on health-related quality of life of patients with heart failure: causal mediation analysis
Authors: Hwang B , Yu H , Jeong Y , Cho H.-J , Lee H.-Y 
Published: October 2021

Abstract

Background/Introduction
Educational interventions have been developed and tested in an attempt to improve health-related quality of life (HRQOL) for patients with heart failure (HF). While some have shown satisfactory results, the mechanism of the intervention effect on HRQOL remains unclear.

Purpose
To explore whether HF knowledge, self-care behaviours, self-care maintenance, self-care confidence, or social support mediates the effect of intervention on HRQOL of patients with HF

Methods
We analysed data from a randomized controlled trial testing the effect of an educational intervention for patients with HF. The intervention group (n=60) received 1-hour single session education followed by 8-week telephone follow-ups, and the control group (n=62) received care as usual. Study variables were measured at baseline and at 3 and 6 months. Using causal mediation analysis described by Valeri & VanderWeele (2013), we explored the causal pathway between intervention allocation and HRQOL at 6 months with HF knowledge, self-care behaviours, self-care maintenance, self-care confidence, and social support measured at 3 months as potential mediators (Figure 1).

Results
Intervention allocation was significantly associated with HF knowledge, self-care behaviours, self-care maintenance, and self-care confidence at 3 months (all p&lt;0.05), but not with social support at 3 months (p=0.57). In unadjusted models, none of the potential mediators had a significant indirect effect between intervention and HRQOL. When adjusting for age and gender, the indirect effect of self-care behaviours on 6-month HRQOL became significant (indirect effect −6.24, 95% CI: −12.88 to −1.18). When baseline values of the mediator and HRQOL were adjusted in addition to age and gender, the indirect effect of self-care behaviours remained significant (indirect effect −7.18, 95% CI: −13.48 to −2.35) and the indirect effect of self-care maintenance became significant (indirect effect −3.02, 95% CI: −7.94 to −0.07).

Conclusion
Our findings support the mediating role of self-care behaviours on the relationship between the educational intervention and HRQOL of patients with HF. In order to successfully improve HRQOL of patients with HF, educational interventions should aim to promote self-care behaviours, especially by encouraging treatment adherence and self-monitoring.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Seoul National University, College of Medicine Figure 1. Mediation model
The cardiac amyloidosis clinical pathway implementation: a real world experience
Authors: Brons M , Rutten F.H , Minnema M.C , Baas A.F , Asselbergs F.W , Oerlemans M.I.F.J 
Published: October 2021

Abstract

Background/Introduction
Prognosis for patients with cardiac amyloidosis (CA) is determined by disease stage at diagnosis, underlining the importance of timely referral. In 2018, a CA clinical pathway was implemented in an Amyloidosis Expert Center in The Netherlands to increase regional awareness.

Purpose
To evaluate the impact of CA clinical pathway implementation.

Methods
Patients diagnosed before implementation (2007–2018; T1) were retrospectively compared to the period after clinical pathway implementation (2019–2020; T2). Demographics and disease characteristics were collected from electronic health records.

Results
In total, 113 patients were diagnosed, mean age 67.8±8.5 years, 26% female. AL-CA was diagnosed in 62%, ATTR-CA in 38%. The number of CA diagnoses/year increased over time (Figure 1). NYHA class III (45% vs. 24%,p=0.04), CA stage (MAYO/Gillmore stage III or IV; 59% vs. 33%, p=0.03) and delay between symptoms and diagnosis (14.5 vs. 8.4 months, p&lt;0.01) improved considerably between T1 and T2. Reasons for referral changed over time, with increasing awareness for right ventricular hypertrophy (9% vs. 36%) and unexplained HFpEF (22% vs 38%).

Conclusion
CA patients were diagnosed earlier with less severe symptoms. Clinical pathway implementation facilitated regional increased awareness and improved timely referral.

Funding Acknowledgement
Type of funding sources: None.
Bone-vessels relationships: association between calcifications of the iliac arteries with vertebral fractures in hemodialysis patients – results from the VIKI study
Authors: Fusaro M , Tripepi G , Politi C , Aghi A , Taddei F , Schileo E , De Caterina R 
Published: October 2021

Abstract

Background
Vascular calcification and fragility fractures are common age-related disorders, associated with high morbidity and mortality especially in end-stage renal disease. Skeletal disorders occur in dialysis patients. Few studies have provided data on the prevalence of vertebral fractures (VF) and their association with large artery calcifications.

Purpose
We evaluated the relationship of iliac arteries calcifications (IACs) and abdominal aorta calcifications (AACs) with the risk for VFs in hemodialysis (HD) patients.

Methods
The VIKI Study is a cross-sectional study involving 387 HD patients from 18 Italian dialysis centers, assessing demographic, clinical and biochemical data in such patients. Biochemical data included bone health markers such as vitamin K levels, vitamin K-dependent proteins, vitamin 25(OH)D, alkaline phosphatase, parathormone, calcium, phosphate, Bone Gla Protein and Matrix Gla Protein. The presence of VF, IACs and AACs were determined through standardized radiograms of the spine. A &gt;20% reduction of vertebral body height was considered a VF. We quantified vascular calcifications by measuring the length of calcium deposits along the abdominal arteries, classifying the degree of severity for the IACs and AACs with a specific score (mild: 0.1–3 cm; moderate: 3.1–5 cm; and severe &gt;5 cm) previously validated for AACs.

Results
The prevalence of IACs was 56.1%, and of AACs 80.6%. After adjusting for confounding variables, the presence of IACs was associated with 73% higher odds of VF (p=0.028), whereas we found no association (p=0.294) for AACs. The presence of IACs associated with VF irrespective of calcification severity. Patients with IACs had lower levels of the vitamin K2, menaquinone 7 (0.99 vs 1.15 ng/ml; p=0.003), and deficiency of this marker became greater when adjusting for triglyceride levels (0.57 vs 0.87 ng/ml; p&lt;0.001).

Conclusions
The presence of IACs, regardless of their extent, appears to be a clinically relevant risk factor for VFs. The association is further enhanced by including vitamin K, a main player in bone and vascular health, in the model. Prospective studies are needed to confirm these findings both in chronic kidney disease patients and in the general population.

Funding Acknowledgement
Type of funding sources: None.
Protection of bone mineral density in heart failure patients:audit on current clinical practice in a busy tertiary care hospital cardiology department in Ireland
Authors: Tariq S , Stroiescu A , Mannion J , Caples N , O'Callaghan P , O'Reilly M , Ryan A , Owens P 
Published: October 2021

Abstract

Background
The strong association between heart failure (HF) and osteoporosis is well recognised. Heart failure, due to its multiple risk factors and common pathogenesis with osteoporosis can lead to low bone mineral density (BMD) and increase the risk of fragility fractures. The mortality of HF patients following these fractures is high. Current National Osteoporosis Foundation Guidelines recommend that pharmacological therapy should be reserved for postmenopausal women and men aged 50 years or older who present with a hip or vertebral fracture, where the vertebral fractures may be clinical or identified on a radiograph alone.

Methods
Most HF patients have frequent chest radiographs over their course years. We aimed to audit the prevalence of osteoporosis and current practice of prescribing BMD-protection in patients attending the HF clinic in a busy tertiary care hospital in Ireland. 100 patients attending the clinic in the last one year were randomly selected and clinical, medication and chest radiograph information on this cohort was collected via the hospital electronic information system. All those patients with Radiologist confirmed vertebral compression fractures (VCF) on their plain chest radiographs were audited regarding osteoporosis screening and bone protection prescription.

Results
Due to limited penetration,18 out of 100 chest radiographs were inconclusive,reducing the sample size to 82. 9 out of the remaining 82 patients had radiologist confirmed VCF on their plain chest radiographs whereas 2 patients had VCF incidentally picked up on their lumbar spine x-rays. All patients were aged more than 50. 4 were female and 7 male. Median ejection fraction calculated was 35%. 3 out of 11 were smokers,8 had atrial fibrillation and were on anticoagulation,4 had DM-II and 2 had CKD. 10 were on loop diuretics. Of note,4 patients were on calcium and vitamin D supplements but only 1 patient was on antiresorptive therapy for osteoporosis.

Conclusion
Despite its strong association with heart failure,Osteoporosis remains undertreated in this patient cohort.Due to the significant mortality and morbidity associated with major osteoporotic fractures, doctors should carefully assess and screen heart failure patients for osteoporosis and initiate specific therapy where indicated.

Funding Acknowledgement
Type of funding sources: None.
Cancer incidence and mortality according to pre-existing heart failure in a community-based cohort
Authors: Bertero E , Robusto F , Rulli E , D'Ettorre A , Staszewsky L , Maack C , Lepore V , Latini R , Ameri P 
Published: October 2021

Abstract

Background
Studies assessing whether heart failure (HF) is associated with an excess risk of cancer and cancer-related mortality yielded conflicting results. Here, we assessed the incidence and mortality of cancer according to the presence of HF in a community-based cohort.

Methods
By reviewing the health care records of the Puglia region in Italy, we first selected individuals ≥50-year-old, with no history of cancer within 3 years before the baseline evaluation and ≥5 years of follow-up, during the period from January 1st, 2005 to December 31st, 2013. Next, we matched 1:1 104,020 subjects with HF at baseline and 104,020 controls based on age, sex, Charlson Comorbidity Index, Drug-Derived Complexity Index, and follow-up duration. Cancer incidence and mortality were analyzed by Kaplan-Meier method and Cox regression models. Fine and Grey's regression model was also used to compare cancer-specific mortality while taking into account the competing risk of non-cancer death.

Results
Overall, the mean age of the study population was 76±10 years and the mean follow-up was 5.7 years. The incidence rate of cancer in HF patients and controls was 21.36 (95% CI, 20.98–21.74) and 12.42 (95% CI, 12.14–12.72) per 1000 person/years, respectively, corresponding to a 76% higher risk of incident cancer in HF patients (HR, 1.76; 95% CI, 1.71–1.81). HF patients also died from cancer more frequently than controls (HR 4.11; 95% CI, 3.86–4.38; Figure 1). This excess mortality was highest when age was &lt;70 years (HR 7.54, 95% CI 6.33–8.98), and declined in subjects aged 70–79 years (HR 3.80, 95% CI 3.44–4.19) and ≥80 years (HR 3.10, 95% CI 2.81–3.43). The association of HF with cancer mortality was confirmed in the competing risk analysis (HR 3.48, 95% CI 3.27–3.72), as well as the interaction with age: &lt;70 years of age: HR 6.65, 95% CI 5.60–7.94; 70–80 years: HR 3.14, 95% CI 2.84–3.48; and ≥80 years: HR 2.81, 95% CI 2.55–3.10.
The HF-related risk applied to the majority of cancer types, with the exception of neoplasm of the male reproductive system. Interestingly, among HF patients a high consumption of loop diuretic (&gt;37.5 mg/d of furosemide) was associated with a higher mortality for cancer (HR 1.34, 95% CI 1.26–1.42 vs. ≤37.5 mg/d).

Conclusions
The analysis of this large community-based sample suggests that HF does portend an increased risk of cancer and cancer-related mortality, which is blunted, yet remains substantial, with increasing age and competing risk of dying from other causes. The risk of cancer may be heightened when HF is poorly compensated.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Cancer mortality in HF patient