bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pacemaker upgrade to CRT-D or CRT-P without prior ventricular arrhythmias: a long-term single-centre retrospective analysis
Authors: Schwertner W.R , Veres B , Kuthi L , Behon A , Eperke M , Tokodi M , Kosztin A , Kovacs A , Osztheimer I , Zima E , Geller L , Merkely B 
Published: October 2021

Abstract

Background
Cardiac Resynchronization Therapy (CRT) can reverse the harmful effects of right ventricular pacing (RVP). Data are sparse on comparing all-cause mortality among patients undergone CRT-defibrillator (CRT-D) or CRT-pacemaker (CRT-P) upgrade from pacemakers without prior ventricular arrhythmias (VAs).

Purpose
We compared the differences in long-term all-cause mortality, postprocedural complications and the occurrence of VAs among patients receiving CRT-D or CRT-P upgrade.

Methods
Patients with a previously implanted conventional pacemaker (PM) developing heart failure (HF) despite optimal medical treatment and high rates of RVP, were included. Altogether 270 patients were investigated, 83 (30.7%) upgraded to CRT-D, 187 (69.3%) to CRT-P in our retrospective registry. The primary endpoint was all-cause mortality, secondary endpoints were malignant VAs and implantation-related complications.

Results
CRT-D upgrade patients were more likely to be males, have a favourable renal function and lower left ventricular ejection fraction (LVEF). During the median follow-up time of 3.7 years, 25 (30.1%) of CRT-D and 131 (70.1%) of CRT-P upgrade patients reached the primary endpoint. The CRT-D upgrade group showed a lower risk of all-cause mortality in the total cohort (HR: 0.55; 95% CI: 0.38–0.78; p=0.004) and in the ischaemic subgroups compared to CRT-P. After adjustment, CRT-D, ischaemic HF aetiology and LVEF have been confirmed as independent predictors of all-cause mortality. Malignant VA occurrence was higher among CRT-D patients (10.8% vs 1.1%; p=0.001), while no difference was observed in the rate of complications between the two patient groups. However, lead removal was performed more frequently (13.3% vs 1.1%; p&lt;0.001) during CRT-D upgrade procedures compared to CRT-P.

Conclusions
Patients among the total and ischaemic HF aetiology subgroup benefited more from the CRT-D upgrade, although VAs and lead removal were more common than in the CRT-P group.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the ÚNKP-20-3-I-SE-43 New National Excellence Program if the Ministry for Innovation and Technology in Hungary. Project no. NVKP_16-1–2016-0017 (“National Heart Program”) has been implemented with the support provided by the National Research, Development and Innovation Fund of Hungary, financed under the NVKP_16 funding scheme. The research was financed by the Thematic Excellence Programme (2020-4.1.1.-TKP2020) of the Ministry for Innovation and Technology in Hungary, within the framework of the Therapeutic Development and Bioimaging thematic programmes of the Semmelweis University. All-cause mort of pts after UPG
QRS narrowing predicts left ventricular reverse remodelling after resynchronization therapy in patients with end-stage heart failure
Authors: Neves Pereira M , Leite P.V.H , Dias G , Cardoso A.F , Tinoco M , Azevedo O , Cordeiro F , Ribeiro S , Ferreira F , Sanfins V , Lourenco A 
Published: October 2021

Abstract

Introduction
Cardiac resynchronization therapy (CRT) is an established treatment for heart failure (HF) patients, however one-third of the patients fail to benefit from CRT. The relationship between the QRS duration, severity of mechanical dyssynchrony and efficacy of CRT is not completely understood. We determined if QRS duration shortening after CRT implantation was predictive of left ventricular reverse remodelling.

Methods
We retrospectively enrolled 227 patients undergoing CRT implantation between 2013 and 2020 according to the guidelines. 88 patients were included in our analysis, from whom all data were available, and these represent our sample. Clinical, electrocardiographic and echocardiographic parameters were evaluated at baseline and after 6 months of CRT implantation. Response to CRT was defined as a reduction in left ventricular end-diastolic volume (LVEDV) &gt;15%. Linear regression models were used.

Results
88 patients were included (mean age 69±10 years, 62.5% males, 36.4% ischemic etiology). Baseline left ventricular ejection fraction (LVEF) was 27,5±5,8% and LVEDV was 181±69 ml. After 6 months of CRT, 52 patients (59.1%) were considered responders. Baseline LVEDV was superior in responders when compared with non responders (199±85 ml vs 168±53 ml, p=0.038). No significant differences were noted in male gender (p=0.823), ischemic cardiomyopathy (p=0.065), LVEF (p=0.853), atrial fibrillation (p=0.390), left bundle branch block (p=0.950) or biventricular pacing (p=0.154) between them.
QRS duration at baseline was similar between responders and non-responders (165±17 ms vs 163±17 ms, p=0.620). After 6 months of CRT, the reduction of QRS duration in responders was significantly higher than non-responders (p&lt;0.001).
QRS duration was reduced from 165±17 ms to 136±15 ms in responders vs 163±17 ms to 160±17 ms in non-responders, (p&lt;0.001). The change in QRS duration positively correlated with the change in LVEDV (0. 654; p&lt;0.001). Multi-linear regression analysis suggested that QRS duration shortening had a significant effect on LVEDV (y = 14,375 + 1.354 X, R2 0.337, p&lt;0.001)

Conclusion
QRS duration shortening after CRT implantation was predictive of LV reverse remodelling in end-stage heart failure patients. Further prospective studies should be conducted to assess the prognostic value of QRS narrowing in response to CRT.

Funding Acknowledgement
Type of funding sources: None.
Adherence to guidelines of diagnostic and therapeutic practices for suspected infections of cardiac implantable electronic devices
Authors: De Ciancio G , Filippetti L , Blangy H , Huttin O , Goehringer F , Juilliere Y , Sadoul N , Selton-Suty C 
Published: October 2021

Abstract

Background
Despite guidelines describing the optimal diagnostic and therapeutic procedures of patients with suspected infection of cardiac implantable electronic device (CIED), the management of such patients is often challenging.

Purpose
The aim of this study was to describe our diagnostic and therapeutic practices for suspected CIED infection and to compare them to European Heart Rhythm Association (EHRA) guidelines.

Methods
Patients hospitalized in our tertiary care hospital for suspected CIED infection from 2014 to 2019 were retrospectively included. We applied the EHRA classification and compared diagnostic and therapeutic management to EHRA guidelines.

Results
Among 184 patients (mean age 72.3±12.4 years), 137 had a proven infection of the lead (either by TTE/TEE, by [18F]FDG PET/CT, or by positive culture of the lead) or an isolated pocket infection without proof of lead infection and 47 had no proof of infection of CIED.
According to EHRA classification, CIED infection was considered as definite in 145 patients, possible in 31 and excluded in 8.
Regarding recommended diagnostic procedures, blood cultures were performed in 90.8%, TTE in 97.8%, TEE in 85.9%, [18F]FDG PET/CT in 50.5% and imaging for embolisms in 78.3% of the patients.
Compared to therapeutic recommendations for the 145 cases of definite CIED infection, device removal was performed in 96 patients (66.2%), antibiotic therapy was prescribed in 130 (89.7%), with a duration equal or superior to the one recommended in 105 (72.4%) of the patients.
One-year survival rate was 66.3% and was better in patients with device removal than in patients without, both in the whole population (respectively 77.7% and 48.6%) and in the patients with definite CIED infection (80.0% vs 49.0%). After adjustement on age and Charlson's score, patients without device removal had a significantly higher risk of 1-year mortality (HR=3.40 [1.84–6.26], p=0.0001).

Conclusion
Suspicion of CIED infection are difficult situations. The use of theoretical classification helps to define the different types of cases and the resultant therapeutic approach.
In daily practice, our study shows that the strict adherence to these guidelines is not always possible. This study shows a relatively good use of diagnostic procedures. However, theoretical advice for medical therapy and removal procedures are not always properly followed. To improve patients' prognosis, infected device removal must be systematically discussed in multidisciplinary endocarditis team, weighing the benefit-risk ratio of the strict appliance of the guidelines.

Funding Acknowledgement
Type of funding sources: None. Diagnostic comparisonTherapeutic comparison
Subclavian versus axillary vein puncture for implantation of cardiac electronic devices. A meta-analysis
Authors: Anagnostopoulos I , Kousta M , Kossyvakis C , Lakka E , Paraskevaidis N.T , Giannopoulos G 
Published: October 2021

Abstract

Background
Implantation of CIED has become a daily practice for patients with rhythm disturbances, those with an indication for primary or secondary sudden cardiac death prevention as well as for patients with heart failure and marked ventricular dyssynchrony. Most of the complications observed following implantation seem to be procedure-related. The latter has led many physicians to replace the classic subclavian approach with alternative techniques such as cephalic vein cut-down and axillary vein puncture (AVP). Recent data support that these techniques may be associated with similar success rates and lower adverse events.

Purpose
This meta-analysis was performed to compare axillary to subclavian vein puncture (SVP) for implantation of cardiac implantable electronic devices (CIED), in terms of safety and efficacy.

Methods
We searched MedLine, via PubMed, for studies comparing subclavian to axillary vein approach in terms of safety and efficacy. Safety endpoints were considered the incidence of pneumothorax, device related infections and major bleeding events. Efficacy and feasibility were assessed by the incidence of lead failure (lead dislodgement, lead fracture or insulation defects) and the number of successfully cannulated veins, respectively. Studies were judged as eligible if they reported at least one of the predefined outcomes. Effect size was calculated using the risk difference along with the corresponding 95% confidence interval (CI). A random- effects DerSimonian-Laird model was adopted.

Results
Seven studies fulfilled the inclusion criteria and were included in the final analysis, resulting in 3642 patients (59.1% males) with a pooled mean (SD) age of 66.1 (12.7) years. Axillary vein puncture (AVP) was performed in 45.8% of them. All, but one study, used fluoroscopic guidance (with or without venography) for axillary vein cannulation. The CIED most commonly implanted was a permanent pacemaker (73%). Both techniques resulted in similar percentages of successful cannulations (1066/1099 for AVP and 906/931 for SVP, RD: 0; 95% CI: −0.01–0.01, I2: 0%, Figure 1A). There was a significantly higher risk for pneumothorax with the subclavian approach (RD: 0.02; 95% CI: 0.01–0.03, I2: 49.31%, Figure 2A). No significant differences were observed regarding the incidence of bleeding and infections (Figure 2B, 2C). SVP was also associated with a significantly increased risk for lead failure (RD: 0.01; 95% CI: 0.00–0.03, I2: 48.47%, Figure 1B).

Conclusions
AVP seems to be a feasible approach for implantation of CIED. Moreover, it seems to be both a more safe and effective choice compared to SVP, as it is associated with reduced risk for pneumothorax and lead failure. More data especially comparing AVP to cephalic cut-down are needed to safely guide the daily practice.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Prediction of functional capacity by the HFA-PEFF score in patients with acute decompensated heart failure with preserved ejection fraction: a post-hoc analysis from the PURSUIT-HFpEF registry
Authors: Iwakura K , Onishi T , Sotomi Y , Okada M , Koyama Y , Okamura A , Tamaki S , Yano M , Hayashi T , Yamada T , Yasumura Y , Fujii K , Hikoso S , Sakata Y 
Published: October 2021

Abstract

Background
Diagnosing heart failure with preserved ejection fraction (HFpEF) is still challenging, and the H2FPEF- and the HFA-PEFF score were proposed as simple and reliable diagnostic tools. We recently reported that the HFA-PEFF score was significantly associated with the composite endpoint of all-cause death and heart failure readmission in patients with acute decompensated HFpEF (Sotomi. Eur J Heart Fail, in press).

Purpose
To investigate the relation whether the HFA-PEFF or H2FPEF score can evaluate functional capacity in patients with HFpEF

Methods
We calculated H2FPEF score and the second step of HFA-PEFF score among the registered patients in the PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study, which is a multicenter registration of patients hospitalized for acute decompensated HFpEF. We performed 6 minute walk (6MW) test and measured NT-proBNP before discharge. We followed the study patients for median of 360 days (IQR 237–630 days) to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke).

Results
We enrolled 757 patients (age 81±9 years, male gender 45%) hospitalized for acute decompensated HFpEF for the present study. The H2FPEF score was obtained in 588 (77.7%) patients and all patients had ≥2 points. The HFA-PEFF score was obtained in 615 (81.2%) patients, though global longitudinal strain was not available. We divided these patients into 3 groups based on the HFA-PEFF score (score 2 to 4, 5, and 6) or on the H2FPEF score (score 0 to 3, 4 to 5 and 6 to 8). There were a significant difference in NT-pro BNP between 3 groups based on HFA-PEFF score (p=0.01, Table 1), and patients with score 6 had significantly higher NT-proBNP than those with score 2 to 4 (p=0.02). A significant difference was observed in 6MW distance among these groups (p=0.04, Table), and those with score 6 had significantly shorter distance than those with score 2 to 4 (p=0.04). Cox proportional hazard model selected HFA-PEFF score as a significant predictor for MACE, and Kaplan-Meier survival analysis demonstrated that classification of HFA-PEFF score significantly stratified the patients' risk for MACE. On the other hand, there was no significant difference in 6MW distance among 3 groups based on H2FPEF score (p=0.53), and H2FPEF score was not an independent predictor for MCE by the Cox model analysis. Moreover, the lowest H2PEF score group had higher NT-proBNP than other 2 groups (p=0.02)

Conclusions
The HFA-PEFF score predicted functional capacity as well as prognosis in patients hospitalized for HFpEF, while the H2PEF score did not.

Funding Acknowledgement
Type of funding sources: None. Table 1
Recurrent heart failure hospitalizations in patients with preserved ejection fraction: predictors and outcome
Authors: Schrutka L , Seirer B , Frommlet F , Binder C , Duca F , Rettl R , Dachs T.M , Dalos D , Badr-Eslam R , Kastner J , Hengstenberg C , Bonderman D 
Published: October 2021

Abstract

Background
Heart failure with preserved ejection fraction (HFpEF) is the most common form of HF and its prevalence is approaching epidemic proportions. Current treatment strategies aim to improve clinical status and reduce mortality rates. Episodes of acute HF are one of the main reasons for hospitalization in people over 65 years; however, they have not been well studied in HFpEF patients yet.

Objectives
The aim of this study was to investigate the impact of recurrent HF hospitalizations on long-term outcomes and to find predictors for subsequent events.

Methods
Between December 2010 and December 2019, 422 patients with confirmed HFpEF were enrolled in this study and prospectively followed.

Results
During follow-up, 190 HFpEF patients (45%) experienced HF hospitalizations with a median frequency of 2 (IQR: 1–4). Those presenting with acute HF had higher body mass indices (p=0.018), worse performance in 6-minute walking tests (p&lt;0.001), higher levels of N-terminal prohormone of brain natriuretic peptide (NT-proBNP, p&lt;0.001) and, compared to stable patients, a larger proportion suffered from New York Heart Association functional class ≥ III (p&lt;0.001). Furthermore, baseline left ventricular diastolic dysfunction (early mitral inflow velocity/early diastolic mitral annular velocity; p=0.002) as well as right ventricular afterload (pulmonary artery wedge pressure; p&lt;0.001) were more pronounced in patients with acute deteriorations. Over the observation period 107 patients (25%) died. Kaplan-Meier curves revealed increasingly worse survival in patients with recurrent HF events (5-years survival: 1 HF event 66% vs ≥3 HF events 53%, p&lt;0.001; Figure). Time to last hospitalization was a strong predictor of survival with an adjusted HR of 2.5 (95% CI 1.63–3.98; p&lt;0.001) in multivariate Cox regression analysis. Predictors of recurrent HF hospitalization were 6-minute walking distance (OR: 0.07, CI 0.02–0.22; p=0.001), systolic pulmonary artery pressure (OR: 1.05, CI 1.03–1.07, p=0.001) and NT-pro BNP (OR: 4.92, CI: 2.68–9.04, p=0.001)

Conclusions
HFpEF patients experiencing recurrent HF hospitalizations have worse long-term outcome. Intensive efforts should be made to maintain HFpEF patients compensated over time.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis
Peak atrial longitudinal strain predicts exercise tolerance in heart failure with preserved ejection fraction
Authors: Sengupta S , Mohan J.C , MacGowan G.A , Jakovljevic D.J 
Published: October 2021

Abstract

Purpose
The present study i) determined left atrial (LA) and left ventricular (LV) strains at rest and in response to exercise in patients with heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF), and ii) assessed the relationship between LA and LV strains and exercise tolerance.

Methods
Forty HFpEF patients (age 59±7 yrs; 25 females), 40 stable HFrEF patients (age 57+6 yrs, 15 females) and 20 controls (age 56+6 yrs, 13 females) underwent baseline clinical and biochemical assessment, resting and exercise stress transthoracic echocardiography using modified Bruce protocol. Speckle-tracking echocardiography was performed to define peak atrial longitudinal strain (PALS) and left ventricular global longitudinal strain (LVGLS). LA stiffness index and LV stiffness index were also derived.

Results
Compared to healthy controls, HFpEF and HFrEF showed significantly lower PALS at rest (34.03±1.85 vs. 23.06±4.69 vs. 11.51±1.44%, p&lt;0.01) and after exercise (34.41±1.24 vs. 18.48±3.51 vs 10.47±1.49, p&lt;0.01 for both). In response to exercise, the PALS significantly reduced in HFpEF by 26%, but only 8% in HFrEF and remained unchanged in controls. LA stiffness index was higher in HFpEF and HFrEF compared to healthy controls at rest (0.57±0.22 vs. 1.19±0.63 vs. 0.27±0.06, p&lt;0.01) and in response to exercise (0.83±0.46 vs. 1.37±0.63 vs. 0.33±0.04, p&lt;0.01). Compared to healthy controls, HFpEF and HFrEF demonstrated significantly lower LVGLS at rest (−20.27±0.98 vs. −15.89±2.72 vs.-11.14±3.40%, p&lt;0.01) and after exercise (−19.9±0.8 vs.-15.5±3.18 vs.-11.01±2.6%, p&lt;0.01). LV stiffness index was significantly higher in HFpEF and HFrEF compared to healthy controls at rest (0.16±0.05 vs. 0.14±0.07 vs. 0.11±0.02, p&lt;0.01) and in response to exercise (0.18±0.07 vs. 0.15±0.06 vs. 0.13±0.02, p&lt;0.01). Exercise tolerance i.e. exercise duration was significantly lower by 28% and 30% in HFpEF and HFrEF compared with controls (363±152 vs. 352±91 vs. 505±42, p&lt;0.01). There was a significant relationship between peak atrial longitudinal strain and exercise tolerance in HFpEF (r=0.32, p=0.04).There was no significant relationship between exercise tolerance and LVGLS (r=0.058, p=0.72), LA stiffness (r=−0.17, p=0.3), LV stiffness (r=0.88, p=.59). There was no significant relationship between exercise tolerance and PALS (r=0.021, p=0.89) or LVGLS (r=0.12, p=0.48) in HFrEF.

Conclusion
HFpEF and HFrEF are associated with reduced left atrial and left ventricular strains and increased arial and ventricular stiffness.Peak atrial longitudinal strain is a significant determinant of exercise tolerance in HFpEF but not in HFrEF.

Funding Acknowledgement
Type of funding sources: None.
Heart failure re-hospitalization differently affects the following mortality in patients with reduced, mid-range and preserved LVEF
Authors: Abe T , Jujo K , Watanabe S , Kishihara M , Shirotani S , Takada T , Yoshida A , Saito K , Hagiwara N 
Published: October 2021

Abstract

Introduction
The recent advances in the treatment for heart failure with reduced ejection fraction (HFrEF) have been remarkable, while no therapy has convincingly improved the prognosis in HF patients with preserved (HFpEF) and mid-range (HFmrEF) ejection fraction. Frequent decompensations of HF lead to progressive deterioration of cardiac and renal function, and quality of life. Hence, prior studies have reported that the mortality of HFrEF patients increases as hospitalization for HF repeats. However, it is still unclear whether this trend applies for HFpEF and HFmrEF patients.

Purpose
We aimed to compare the prognostic impact of re-hospitalization due to HF on cardiovascular death (CVD) among HFrEF, HFmrEF and HFpEF patients.

Methods
This observational study included 1,930 consecutive patients who were hospitalized for worsening of HF and discharged alive. Of them, patients who have never or have not been hospitalized for HF at least last 2 years, were finally analyzed. Patients were consisted of the population with HFrEF (EF&lt;40%, n=421), HFmrEF (EF 40–49%, n=202) and HFpEF (EF&gt;50%, n=291). Patients in each EF-classified population were divide into 2 subgroups based on whether patients were re-hospitalized for HF during the observational period, respectively. The primary endpoint of this study was CVD.

Results
During the observation period, Kaplan-Meier analysis showed that patients who were re-hospitalized for HF had higher event rate of CVD in HFrEF group (Log-rank p=0.008, Figure). Even after adjusting with multivariate covariates including age, sex, EF, brain natriuretic peptide and estimated glomerular filtration rate, re-hospitalization for HF was an independent predictor for CVD in HFrEF group (HR: 1.95, 95% CI: 1.11–2.86, p=0.029). However, in HFmrEF group and HFpEF group, there was no significant difference in the rates of CVD between 2 subgroups divided whether patients were re-hospitalized for HF or not (p=0.91, p=0.34, respectively).

Conclusion
Re-hospitalization for HF affected the CVD rate in HFrEF group, but not in HFmrEF and HFpEF groups. The prevention of re-hospitalization for HF is important particularly in HFrEF patients in order to improve cardiovascular mortality.

Funding Acknowledgement
Type of funding sources: None.