bluuebunny/crossref_metadata_2025_split huggingface dataset:
Interleukin-6 and outcomes in patients recently hospitalized with heart failure and preserved ejection fraction
Authors: Mooney L , Jackson C.E , McConnachie A , Myles R , McMurray J.J.V , Petrie M.C , Jhund P.S , Lang N.N 
Published: October 2021

Abstract

Introduction
Inflammation may play a role in the pathophysiology of heart failure with preserved ejection fraction (HFpEF). Interleukin-6 (IL-6) is an important inflammatory mediator but information about its prognostic relevance in HFpEF is lacking.

Purpose
To examine the association between IL-6 and outcomes in patients with HFpEF.

Methods
We assessed the relationship between IL-6 tertile (T1–3) and all cause death, cardiovascular (CV) death and first HF hospitalisation (HFH) in 340 patients admitted to hospital with HFpEF. The association between log IL-6 and outcomes was examined in a Cox regression model adjusted for MAGGIC risk score and log B-type natriuretic peptide (BNP).

Results
Range of IL-6 (pg/ml) was: T1 (0.71–4.27), T2 (4.28–7.91) and T3 (7.94–236.32). Patients with higher IL-6 were older (73.9 versus 70.3 years), more commonly male (58.4% versus 39.5%) and had higher serum creatinine (117.6 versus 106.5 μmol/l), C-reactive protein ([CRP] 17.4 versus 4.4mg/l), troponin I (6.2 versus 5.0μg/l) and BNP (331.0 versus 254.5pg/ml). Rates of CV death and all-cause mortality, but not HFH, remained significantly higher in T3 versus T1 after adjustment. When modelled as a continuous variable, one log unit increase in IL-6 was associated with higher risk of CV death (HR 1.34 [1.05–1.70]), p=0.02) and all cause death (HR 1.41 [1.13–1.75], p=0.002).

Conclusion
In patients recently hospitalised with decompensated HFpEF, IL-6 is an independent predictor of CV death and all-cause mortality after adjusting for the MAGGIC risk score and BNP. The potential utility of IL-6 as a therapeutic target in HFpEF warrants investigation.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Scottish Executive Chief Scientist Office [project grant entitled, “Microvolt T-Wave Alternans in Chronic Heart Failure: A Study of Prevalence and Incremental Prognostic Value” (Ref CZH/4/439)]
Exercise-induced changes of ventricular function in male and female amateur marathon runners as assessed by three-dimensional echocardiography
Authors: Lasocka Z.B , Dabrowska-Kugacka A , Kaleta-Duss A , Lewicka-Potocka Z , Faran A , Danilowicz-Szymanowicz L , Nowak R , Kaufmann D , Raczak G , Lewicka E 
Published: October 2021

Abstract

Introduction
The long-term endurance training is associated with an increased risk of both right (RV) and left ventricular (LV) dysfunction. However, males and females exhibit different cardiac adaptation to exercise. The aim of our study was to evaluate three-dimensional (3D) echocardiographic parameters of ventricular function before and after the marathon in male and female amateur athletes, and compare them between sexes.

Methods
The study included 40 male (39±8 years) and 27 female (40±7 years) amateur athletes. Echocardiography was performed 2–3 weeks before (Stage 1) and immediately after (Stage 2) the marathon run. RV and LV area and function were assessed using standard and 3D echocardiography.

Results
After the marathon, there was a significant increase in the RV size (indexed RV end-diastolic volume, 51.1±12.0 vs. 59.0±9.1 ml/m2, p=0.003 in males; 48.8±11.0 vs. 60.0±11.1 ml/m2, p&lt;0.001 in females), with a decrease in the LV dimensions (indexed LV end-diastolic volume, 57.1±11.9 vs. 53.0±9.4 ml/m2, p=0.026 in males; 66.2±7.9 vs. 60.1±9.5 ml/m2, p=0.001 in females). RV systolic contractility, as assessed by ejection fraction (EF) and fractional area change (FAC), significantly decreased at Stage 2 in both studied groups, while post-race decrease in LVEF was observed only in males (p&lt;0.05 for the interaction sex and stage).

Conclusions
In both male and female amateur athletes, marathon running resulted in RV dilatation and reduction in function, with concomitant decrease in LV dimensions. However, 3D analysis revealed that strenuous exercise alters LV systolic function to a greater degree in men relative to women.

Funding Acknowledgement
Type of funding sources: None.
Comparing the central arterial stiffness indices in the decompensated and compensated states of heart failure: a cohort study
Authors: Youssef G , El Fol A , Ammar W , Sharaf Y 
Published: October 2021

Abstract

Background
Arterial stiffness is strongly linked to the pathogenesis of heart failure (HF), and development of acute decompensation of patients with stable chronic HF.

Purpose
To compare the arterial stiffness indices in patients with heart failure with reduced ejection fraction (HFrEF) during hospitalization with acute decompensated state, and then three months later after discharge during the compensated state.

Methods
One hundred patients with acute decompensated HFrEF (NYHA class III and IV) and left ventricular ejection fraction (LVEF) ≤35% were included in the study. Fifty-six patients (56%) had ischemic cardiomyopathy (ICM) and the rest had dilated cardiomyopathy (DCM). During the initial and follow up visits, all patients were subjected to full medical history taking, clinical examination, electrocardiography (ECG), transthoracic echocardiography (TTE), routine labs and non-invasive pulse wave analysis (PWA) by the Mobil-O-Graph 24h PWA device for measurement of arterial stiffness parameters.

Results
The mean age was 51.6±6.1 years and 80% were males. There was a significant reduction of the central arterial stiffness indices in patients with HFrEF during the compensated state as compared to their decompensated state values, table (1). During the decompensated state, patients with ICM showed a significantly higher PWV as compared to patients with DCM (9.2±1.1 vs 8.6±1.4 m/sec, P=0.042), patients presented with NYHA FC IV (n=64) showed higher AI (24.5±10.0 vs 16.8±8.6, p&lt;0.001) and PWV (9.2±1.3 vs 8.5±1.2, p=0.021) than patients with NYHA FC III, and despite the relatively smaller number of females, they showed higher stiffness indices than males, table (2).

Conclusion
Central arterial stiffness indices derived from the non-invasive Mobil-O-Graph 24h PWA device in patients with HFrEF were significantly lower in the compensated state as compared to the decompensated state. Patients with ICM, NYHA FC IV and females showed higher stiffness indices in their decompensated state of heart failure.

Funding Acknowledgement
Type of funding sources: None.
Phenotyping the right heart according to left ventricular geometry patterns in severe HFrEF
Authors: Casati M , Bursi F , Mondellini G.M , Santangelo G , Giustiniani A , Massironi L , Tarricone D.G.F , Carugo S , Guazzi M 
Published: October 2021

Abstract

Background
Right ventricular (RV) failure significantly impact on heart failure with reduced ejection fraction (HFrEF) prognosis. How and whether specific functional and geometrical phenotypes of the RV function adapt and combined with left ventricular (LV) geometry is unknown.

Purpose
To test the RV function across LV geometrical patterns looking at respective prognostic roles.

Methods
We retrospectively examined a population of patients homogenously diagnosed with chronic HFrEF (defined as LV ejection fraction (EF) less than 35%) and treated with optimal therapy (OT) and all implanted with ICD for primary prevention of sudden cardiac death. Patients were categorized by echocardiography according to remodeling pattern based on left ventricular mass index and relative wall thickness into four groups: normal geometry (NG), concentric remodeling (CR), concentric hypertrophy (CH) and eccentric hypertrophy (EH). RV parameters were: tricuspid annulus plane systolic excursion (TAPSE), TAPSE/pulmonary artery pressures (PAPs), RV basal diameter and fractional area change (FAC). Outcome variable was all-cause mortality, assessed with multivariable Cox proportional hazard (PH) models.

Results
Among 193 patients (age 66±11 years, 81% men, 74% with ischemic etiology of HF and EF 28±5%) 21% had NG, 3% had CR, 8% had CH, and 68% had EH. Distribution of RV echo parameters across LV remodeling groups is shown in table 1. Over a median follow-up time of 4 (1.9 – 6.1) years, 65 deaths occurred. In multivariable Cox PH models adjusted for age, LVEF, ischemic etiology and LV geometry, TAPSE, TAPSE/PAPs, RV basal diameter and FAC strongly and independently predicted the outcome variable [HR 0.92 (95% C.I. 0.86–0.98), HR 0.08 (95% C.I. 0.01–0.57), HR 1.87 (95% C.I. 1.29–2.71), HR 0.97 (95% C.I. 0.95–1.00), respectively all p-value &lt;0.05].

Conclusion
In a homogeneously defined population of severe HFrEF outpatients receiving OT, the majority showed EH remodeling pattern, which did not predict the primary outcome. LV geometry did not further stratify patients in this high risk group. Conversely, RV dysfunction proved to be a strong predictor of mortality, independently of age, LV function and etiology of HF, regardless LV morphology.

Funding Acknowledgement
Type of funding sources: None.
Hemoglobin, anemia, and clinical outcomes in vericiguat global study in subjects with heart failure with reduced ejection fraction (VICTORIA)
Authors: Ezekowitz J.A , Zheng Y , Cohen-Solal A , Melenovsky V , Escobedo J , Butler J , Hernandez A.F , Lam C.S.P , O'Connor C.M , Pieske B , Ponikowski P , Voors A.A , McMullan C , Roessig L , Armstrong P.W ,   the VICTORIA Study Group
Published: October 2021

Abstract

Background
In the VICTORIA trial of patients with HFrEF after a worsening HF event, anemia occurred more often in patients treated with vericiguat (7.6%) compared with placebo (5.7%). We explored the association between vericiguat, baseline hemoglobin, and anemia and also whether hemoglobin was related to the benefit of vericiguat in HF.

Methods
Anemia was defined as a hemoglobin &lt;13.0 g/dL in men and &lt;12.0 g/dL in women (WHO anemia). Adverse events reported as new anemia were also evaluated (AE anemia). We evaluated the risk-adjusted relationship between baseline hemoglobin (as both quartiles and continuous variable), hematocrit, and hematinic indices with the primary outcome (composite of cardiovascular death or heart failure hospitalization). Time-updated hemoglobin relationship was also examined.

Results
Of 4812 patients with baseline hemoglobin data available, 1719 (35.7%) were WHO anemic; median hemoglobin was 13.4 g/dL (IQR 12.1 to 14.7 g/dL). In total, 1643 patients had WHO anemia at 16 weeks (of which 284 were new from baseline for vericiguat and 219 for placebo) and this occurred more often in the vericiguat group than the placebo group (P&lt;.001). Subsequently, there was no further decline in hemoglobin over the 96 weeks of follow-up (Figure A). The ratio of hemoglobin/hematocrit remained constant and none of the hematinic indices including red cell density width, mean corpuscular volume, white blood cell or platelet counts changed over time. Overall, AE anemia occurred in 342 patients (7.1%) and was more frequent in those with a lower baseline hemoglobin (hemoglobin Q1: 184 [14.5%], Q2: 94 [7.9%], Q3: 40 [3.4%], Q4: 24 [2.1%]; p&lt;.001). Whereas outcomes were associated, quartiles of baseline hemoglobin were not related to the treatment benefit of vericiguat (compared with placebo) for the primary outcome (Figure B). Additionally, analysis of the time-updated hemoglobin values revealed no association with the treatment effect of vericiguat (compared with placebo) on the primary outcome.

Conclusions
Anemia was present at baseline in over one-third of patients in the VICTORIA trial and was generally mild. Lower hemoglobin was associated with greater frequency of clinical events. Although vericiguat modestly lowered hemoglobin by 16 weeks, this effect did not further progress nor influence the association of benefit of vericiguat.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
Impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria
Authors: Saidu H , Mohammed I.Y , Ishaq N.A , Balarabe S.A , Tukur J , Adedeji T.A , Makinde O.N , Adebayo R.A , Umar H , Isezuo S.A , Karaye K.M ,   PEACE REGISTRY INVESTIGATORS
Published: October 2021

Abstract

Background
There are a few and conflicting data in the literature about parity and maternal cardiac function.

Purpose
The purpose of this study was to assess the impact of parity on cardiac structure and function in apparently healthy pregnant women in Nigeria.

Methods
This was a cross-sectional study carried out in 4 tertiary centers in Kano, and 1 in Ile- Ife, Nigeria. 112 apparently healthy pregnant women were consecutively recruited between 28thand 38th weeks of gestation. Left ventricular (LV)systolic dysfunction was defined as LV ejection fraction of below 50%, and diastolic dysfunction was graded using mitral filling pattern and tissue velocities.

Results
LV systolic dysfunction and diastolic dysfunction were found in 6 (5.4%) subjects and 20 (17.9%) subjects respectively. Age (p= &lt;0.0001), left atrial (LA)size (P= &lt;0.0001), interventricular septal thickness at end diastole (IVSD) (p=0.005) and posterior wall thickness at end diastole (PWTD) (p=0.004) increased progressively with parity (Table 1). There was significant positive correlation between parity and age (r=0.475, p= &lt;0.0001), LA size (r=0.332, p= &lt;0.0001), IVSD (r=0.264, p=0.005) and PWD (r=0.343, p= &lt;0.0001). LV systolic function was not significantly associated with parity.

Conclusion
Our findings suggests that parity causes significant myocardial remodeling in apparently healthy pregnant women that should be taken in to consideration while interpreting their echocardiograms.

Funding Acknowledgement
Type of funding sources: None.
Sex differences on new-onset heart failure in patients with known or suspected chronic coronary syndrome
Authors: Lorenzo Hernandez M , Nunez J , Minana G , Palau P , Lopez-Lereu M.P , Monmeneu J.V , Marcos V , Rios-Navarro C , Gavara J , Perez N , De Dios E , Nunez G , Nunez E , Chorro F.J , Bodi V 
Published: October 2021

Abstract

Background
The impact of sex in patients with chronic coronary syndrome (CCS) has been widely reported, but little is known about the influence of sex on the risk of new-onset HF in patients with CCS.

Objectives
We aimed to examine sex-related differences and new-onset heart failure (HF) risk in patients with known or suspected CCS undergoing vasodilator stress cardiac magnetic resonance (CMR).

Methods
We prospectively evaluated 5,899 consecutive HF-free patients submitted to stress CMR for known or suspected CCS. Ischemic burden (number of segments with stress-induced perfusion deficit) and left ventricular ejection fraction (LVEF) were assessed by CMR. The association between sex and new-onset HF (including outpatient diagnosis or acute HF hospitalization) was evaluated using a Cox proportional-hazards regression model adjusted for competing events (death, myocardial infarction, and non-CMR-related revascularization).

Results
A total of 2,289 (38.8%) patients were women, and 539 (9.1%) underwent CMR-related revascularization. During a median follow-up of 4.5 years, 610 (10.3%) patients died, 191 (3.2%) suffered a myocardial infarction, 420 (7.1%) underwent CMR-non-related revascularization, and 314 (5.3%) developed new-onset HF. Unadjusted new-onset HF rates were higher in women than in men (1.25 vs 0.83 per 100 person/years, p=0.002) (Figure 1). After comprehensive multivariate adjustment, women showed an increased risk of new-onset HF (HR=1.61, 95% CI: 1.21–2.13, p=0.001). Compared with men, the risk of new-onset HF was higher in women with LVEF &gt;53%.

Conclusions
Compared with men, women with CCS are at a higher risk of new-onset HF. Further studies are needed to unravel the mechanisms behind these sex-related differences.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III and Fondo Europeo de Desarrollo Regional (FEDER) Figure 1
Heart failure in low risk patients with atrial fibrillation, nationwide registry case-control study based on 227811 patients
Authors: Basic C , Hansson P , Zverkova-Sandstrom T , Johansson B , Fu M , Mandalenakis Z 
Published: October 2021

Abstract

Background
Heart failure (HF) is common in patients with atrial fibrillation (AF), and also associated with worse outcome. Consequently, it is commonly included in risk prediction models for AF, used in daily clinical praxis. However, knowledge about the association between solely AF and incidental HF is limited.

Aim
This study aims to evaluate the short and long-term risks for onset of HF in patients with AF and low cardiovascular risk profile.

Methods
All patients with first recorded hospitalization for AF in the Swedish National Patient Register, were included from the 1St January 1987 to 31st December 2018. Each patient with AF was matched by age, sex and county with two controls from the Swedish Total Population Register. Patients &lt;18 years, or with concomitant hypertension, diabetes mellitus, coronary and periphery artery disease, previous stroke or transitory ischemic attack, cardiomyopathy, pulmonary arterial hypertension, congenital heart disease, valvular heart disease and renal failure prior or at baseline were excluded.

Results
In total 227 811 patients and 452 712 controls met the inclusion and exclusion criteria and were included in the study. The incidence rate for incidental HF per 1000 person-year within one year after AF diagnosis was 6.2 (95% CI: 4.5–8.6) among patient 18–34, increased with increasing age and was 142.8 (95% CI: 139.4–146.3) among those &gt;80 years. Within five years the incidence rate decreased in all age categories and was 2.4 (95% CI: 1.8–3.0) among the youngest and 94.0 (95% CI: 92.4–95.6) in the oldest age group. When compared to matched controls from the general population patients with AF had a hazard ratio (HR) and CI 95% to develop HF within one year at 103.9 (46.3–233.1), 34.9 (26.5–45.9), 17.5 (15.5–19.8), 10.3 (9.6–11.1) and 6.1 (5.8–6.4) among patients aged 18–34, 35–49, 50–59, 60–69, 70–79 and &gt;80 years, respectively.

Conclusion
Despite low cardiovascular risk profile AF still carries high risk for developing incidental HF in particular during the first observation year with increasing tendency along with increasing age. Younger patients with AF and without other cardiovascular comorbidities had more than 100 times higher relative risk to develop HF within one year when compared to matched controls.

Funding Acknowledgement
Type of funding sources: None.
Applying the ESC 2016, the H2FPEF, and the HFA-PEFF diagnostic algorithms for heart failure with preserved ejection fraction to the general population – a comparative approach
Authors: Nikorowitsch J , Bei Der Kellen R , Kirchhof P , Magnussen C , Schnabel R , Blankenberg S , Wenzel J.P ,   HCHS Echo
Published: October 2021

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is common in patients presenting with dyspnoea. Nevertheless, diagnosing HFpEF remains challenging. Recently, different algorithms were developed to predict the likelihood of HFpEF.

Purpose
Our objective was to provide an in-depth comparison of the ESC 2016 algorithm, the H2FPEF- and the HFA-PEFF algorithm for diagnosing and characterising HFpEF in the general population.

Methods
The study included 5,613 participants of the population-based H. City Health Study (HCHS), aged 62±8.7 years (51.1% women), that were enrolled between 2016 and 2019. Exclusion criteria were other common causes of dyspnea. We calculated the prevalence and compared characteristics of HFpEF according to the different diagnostic algorithms applying the ESC 2016 heart failure guidelines and the cut-off values suggested by the authors of the HFA-PEFF and H2FPEF score for defining HFpEF.

Results
Unexplained dyspnea was present in 407 (7.3%) subjects. In those, the estimated prevalence of HFpEF was 20.4% (ESC 2016), 12.3% (H2FPEF), and 7.6% (HFA-PEFF). The majority of subjects was classified as HFpEF not excludable according to the HFA-PEFF (57.7%) and the H2FPEF (59.2%) score. For all algorithms, subjects diagnosed with HFpEF showed elevated age and body mass index as well as a higher prevalence of atrial fibrillation, diabetes, and arterial hypertension compared to those without HFpEF or HFpEF not excludable. The distribution of those comorbidities and risk factors varied between the differently diagnosed HFpEF groups with the highest burden in the HFpEF group defined by the H2FPEF score. The overlap of subjects diagnosed with HFpEF according to the different algorithms was very limited.

Conclusion
Unexplained dyspnoea is common in the middle-aged general population. The ESC 2016 algorithm, the H2FPEF-, and the HFA-PEFF score detect different, discordant sub-populations of probands with breathlessness. Further classification of the HFpEF syndrome is desirable.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Innovative medicine initiative Figure 1. Prevalence and concordance of the three HFpEF algorithms in subjects with unexplained dyspnea. Of the 407 subjects with unexplained dyspnea, the prevalence ranged from 20.4% (n=83, ESC 2016 guideline) to 12.3% (n=50, H2FPEF score) and 7.6% (n=31, HFA-PEFF score). The concordance was highest between the ESC 2016 guidelines and the HFA-PEFF score reflected by a kappa coefficient of 0.38 and a reclassification rate of 16%. RecR = reclassification rate.
Left ventricular contractile reserve, coronary flow reserve, and heart rate reserve during dipyridamole stress echocardiography predict survival in non-ischemic heart failure
Authors: Daros C , Ciampi Q , Cortigiani L , Gaibazzi N , Rigo F , Villari B , Antonini-Canterin F , Lorenzoni V , De Nes M , Carpeggiani C , Picano E ,   Stress Echo 2020 study group of the Italian Society of Echocardiography and Cardiovascular Imaging
Published: October 2021

Abstract

Background
Left ventricular contractile reserve (LVCR), coronary flow velocity reserve (CFVR), and heart rate reserve (HRR) have recognized independent impact on outcome in heart failure (HF). They all can be simultaneously measured during dipyridamole stress echocardiography (DSE).

Aim
To assess the value of comprehensive DSE in patients with non-ischemic heart failure.

Methods
We evaluated 613 patients with HF, no history of coronary artery disease and no inducible regional wall motion abnormalities: 270 patients with preserved (≥50%) ejection fraction; 147 with mid-range (40–49%) ejection fraction; 196 with HF and reduced (&lt;40%) ejection fraction. All underwent DSE (0.84 mg/kg in 6') in 5 accredited laboratories. We measured LVCR (abnormal value ≤1.1), CFVR in left anterior descending artery (abnormal value ≤2.0), and HRR (peak/rest heart rate, abnormal value ≤1.22). All patients were followed-up.

Results
Abnormal CFVR, LVCR and HRR occurred in 29%, 44% and 46% of patients, respectively. After a median follow-up time of 20 months (interquartile range 12–32 months), 41 patients died. Annual mortality rate was lowest in patients (n=200) with normal response, and &gt;10-fold higher in patients (n=96) with 3 abnormal criteria: see figure. At multivariable analysis, a reduced HRR (Hazard Ratio = 3.402, 95% Confidence Intervals 1.530–7.565, p=0.003) was the strongest SE independent predictor of all-cause death.

Conclusion
Abnormal LVCR, CFVR and HRR can be frequently observed during vasodilator SE in HF patients. They target different pathophysiological vulnerabilities (myocardial function, coronary microcirculation and cardiac autonomic system) and are useful for outcome prediction.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Consiglio nazionale delle ricerche - Institute of Clinical Physiology Figure 1