bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of waist circumstance with long-term all-cause mortality and cardiac death in patients with a pacemaker
Authors: Xue X , Li XY , Zhao S , Zhang S 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Objective
To explore the association of abdominal obesity with long-term prognosis in patients with a pacemaker.

Methods
Patients in the Summit study were enrolled and divided into groups according to baseline waist circumference: with obesity, normal, and lean. Regular follow-up was performed. The primary endpoint was all-cause mortality, and the secondary endpoint was cardiac death.

Results
In total, 492 patients were included in the analysis. The average baseline waist circumference was 84.2 ± 12.7 cm, and abdominal obesity was observed in 37.6% of patients. During a mean follow-up of 67.2 ± 17.5 months,71 all-cause mortality (14.40%) and 24 cardiac death (4.87%) events occurred. All-cause mortality was associated with higher waist circumference (87.6 versus 83.6 cm, P = 0.014), but not body mass index (23.6 versus 23.5, P= 0.930). Multivariate Cox analysis showed compared with patients with abdominal obesity, lean patients had a significant survival benefit in both all-cause mortality (HR 0.188, 95%CI 0.070-0.505, P = 0.001) and cardiac death (HR 0.097, 95% CI 0.012-0.792, P = 0.029).

Conclusions
Waist circumference was associated with long-term all-cause mortality and cardiac death. Baseline waist circumference less than 80 cm for men and less than 75 cm for women had a significant survival benefit.
The role of cardiopulmonary exercise testing in a contemporary heart failure population
Authors: Garcia Bras P , Valentim Goncalves A , Reis J , Pereira Da Silva T , Ilhao Moreira R , Viegas J , Ferreira V , Castelo A , Rio P , Silva S , Martins C , Coito S , Capile E , Soares R , Ferreira R 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Cardiopulmonary exercise testing (CPET) is used for risk stratification in patients with chronic heart failure (CHF). However, there is a lack of information regarding CPET prognostic power in patients under new HF therapies such as sacubitril/valsartan, Mitraclip, IV iron or SGLT2 inhibitors. The aim of this study was to evaluate the prognostic value of CPET parameters in a contemporary subset of patients with optimal medical and device therapy for CHF.

Methods
Retrospective evaluation of patients with CHF submitted to CPET in a tertiary center. Patients were followed up for 24 months for the composite endpoint of cardiac death, urgent heart transplantation or left ventricular assist device.
CPET parameters, including peak oxygen consumption (pVO2) and VE/VCO2 slope, were analysed and their predictive power was measured.
HF events were stratified according to cut-off values defined by the International Society for Heart and Lung Transplantation (ISHLT) guidelines: pVO2 of ≤12 mL/Kg/min and VE/VCO2 slope of &gt;35.

Results
CPET was performed in 204 patients, from 2014 to 2018. Mean age was 59 ± 13 years, 83% male, with a mean left ventricular ejection fraction of 33 ± 8%, and a mean Heart Failure Survival Score of 8.6 ± 1.3.
The discriminative power of CPET parameters is displayed in the Table.
In patients with pVO2 ≤12 mL/Kg/min, the composite endpoint occurred in 18% of patients. A pVO2 value of ≤12 mL/Kg/min had a positive predictive power of 18% while pVO2 &gt;12 had a negative predictive power of 93%.
Regarding VE/VCO2 slope &gt;35, the composite endpoint occurred in 13% of patients.
A VE/VCO2 slope value of &gt;35 had a positive predictive power of 13% while VE/VCO2 slope &lt;35 had a negative predictive power or 94%.

Conclusion
Using ISHLT guideline cut-off values for advanced HF therapies patient selection, there was a reduced number of HF events (&lt;20%) at 24 months in patients under optimal CHF therapy. While pVO2 and VE/VCO2 slope are still valuable parameters in risk stratification, redefining cut-off values may be necessary in a modern HF population.
Discriminative power of CPET parameters Parameters HR; 95% CI AUC p-value Peak VO2 0.824 (0.728-0.934) 0.781 0.001 Percent of predicted pVO2 0.942 (0.907-0.978) 0.774 0.002 VE/VCO2 slope 1.068 (1.031-1.106) 0.756 0.008 Cardiorespiratory optimal point 1.118 (1.053-1.188) 0.746 0.004 PETCO2 maximum exercise 0.854 (0.768-0.950) 0.775 0.003 Ventilatory Power 0.358 (0.176-0.728) 0.796 0.002 HR Hazard ratio, AUC: Area under the curve, PETCO2: end-tidal CO2 pressure
Prescription pattern of evidence-based pharmacotherapy in heart failure: An age perspective
Authors: Dakhil ZA , Farhan HASAN 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Elderly patients constitute substantial proportion of medical care beneficiaries, in same line; heart failure (HF); an extremely common comorbidity is predominately affecting older patients, yet, age disparity in managing this population still represents remarkable challenge in practice. However, little insight is available regarding adherence to evidence-based pharmacotherapy prescribed for this population in developing countries.

Purpose
this study sought to investigate age-based differences in clinical profile and pharmacotherapy prescription pattern in patients with HF.

Methods
This study recruited hospitalized patients with systolic HF, patientsꞌ demographic characteristics, investigational results as well as prescribed drugs in hospital and at discharge; all were recorded. Patients were grouped according to age into ≥65 years versus ˂65 years.

Results
The study recruited 201 patients, 89 (44.27%) of them at age ≥65 year vs 112 (55.72%) in younger group, mean age of older group was 72.4 ± 7.2 year vs 53.5 ± 8.9 year (p &lt; 0.001), female gender constitutes 39.3% of older group vs 26.8% (p &lt; 0.001), older patients were more to have hypertension (68.5% vs 63.4%, p &lt; 0.001) and AF (19.1% vs 17.9%, p &lt; 0.001) and less to be diabetic than younger counterparts (48.3% vs 54.5%, p &lt; 0.001). IHD was most common cause of HF in both groups (92.1% in older group vs 82.1%), dilated cardiomyopathy caused more HF in younger group (12.5% vs 5.6%). No significant differences between both groups regarding heart rate, blood pressure at presentation nor blood urea, serum creatinine or ejection fraction. However, haemoglobin was lower in older group (12.3 ± 1.8 gm/dL vs 13.5 ± 2.2 gm/dL, p = 0.0001). Older patients were treated less with B-blockers 75.3% vs 79.5% while they were prescribed mineralocorticoid receptor antagonist (MRA) more than younger counterparts (46.1% vs 42.9%, p &lt; 0.001), ACE/ARBs/ARNI were prescribed more in older population (62.9% vs 53.6%, p &lt; 0.001). Among patients with heart failure in general: antiplatelet drugs were prescribed more in older patients 75.3% vs 71.4%, while statins used in 68.5% in elderly vs 69.6% in younger counterparts. However, in the context of HF and IHD, antiplatelet drugs were prescribed less in older patients (81.7% vs 86.95%, p &lt; 0.001) same as statins (74.4% vs 84.8%, p &lt; 0.001).

Conclusions
This study contradicted prior researches as ACEI/ARBs/ARNI and MRA were used more in older patients with HF compared to younger counterparts. However, there is still significant age disparity revealed in form of less use of B-blockers in elderly same as antiplatelet, statin and oral anticoagulant when indicated. Further studies are warranted to determine the predictors for age gap in practice in order to be bridged to achieve better cardiovascular outcomes.
Abstract Figure.
5 years follow-up of patients with heart failure and cardiac resynchronization: baseline variables associated to death
Authors: Oliveira S , Cunha PEDRO , Carmo MIGUEL , Valente BRUNO , Ricardo INÊS , Silva PEDRO , Yang HUA , Delgado ANA , Oliveira LUIS , Pinto FAUSTO , Oliveira MÁRIO , Abreu ANA 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Chronic Heart Failure (HF) has proven to be an increasing challenge for the global health management. Prognosis is affected by pharmacological optimization, comorbidities and risk factors control, lifestyle changes and invasive treatments like resynchronization (CRT) and transplant.

Purpose
To evaluate the association of baseline variables in HF patients, before CRT, with death event at 5 years follow up (FU).

Methods
Single center, post-hoc analysis of a prospective cohort of consecutive HF patients referred to CRT (2013-2015). Demographic data, HF etiology and NYHA class were evaluated at baseline as well as plasmatic of natriuretic peptide (BNP), heart to mediastinum ratio (HMR), left ventricular ejection fraction (LVEF) and volumes. Mortality was evaluated at 5 years. Patients were divided in two groups: "non survivors" and "survivors". Data were analyzed using descriptive statistics. Spearman test was used to evaluate the correlation between baseline variables and death.

Results
102 patients were included (age 68.8 ± 10 years), 68.6% male, 29% ischemic cardiomyopathy, 74% NYHA III/IV, baseline LVEF 26 ± 7. 27% were CRT non-responders. At 5 years follow up 43% died, with 1.96% lost FU. Baseline variables in the two groups are displayed in table 1. Statistical analysis correlating baseline variables with death (Spearman test) showed weak correlation, with the strongest correlation obtained: late HMR with negative correlation 0.34; LV tele-diastolic volume with positive correlation 0.26.

Conclusion
The mortality at 5 years of HF patients with CRT was high (43%). Baseline variables (late HMR, LV tele-diastolic volume) were associated to death. These results should call early attention for a possible worst prognosis in severe HF patients to CRT.
Table 1 "Non survivors" vs "Survivors" “Non Survivors”(n = 44) “Survivors”(n = 56) Age 67,11 ± 11,17 68,14 ± 10,51 Male 35 (80%) 35 (63%) NYHA III/IV 31 (70%) 43 (77%) Ischemic 15 (34%) 14 (25%) BNP 640,95 ± 606,23 370,41 ± 353,36 Late HMR 1,35 ± 0,16 1,47 ± 0,17 LVEF 27 ± 6,77 26 ± 7,47 Non responders 16 (36%) 12 (21%) LVTdV 225 ± 73,28 191 ± 58,5 PCR 10,33 ± 22,85 5,02 ± 9,27
Evolution of muscle strength and physical activity 1 year after heart transplantation: a prospective observational study
Authors: Hornikx M , Van Aelst L , Droogne W , Janssens S , Van Cleemput J 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Heart transplantation (HTX) is a therapeutic option in a selected group of patients with end-stage heart failure. Although cardiac function normalizes after surgery, maximal exercise capacity of HTX-patients after 1 year is only half that of age- and gender matched healthy subjects. Data on the evolution of muscle strength and physical activity after HTX are scant. Having this knowledge might help to optimize rehabilitation programs.

Purpose
To describe changes in muscle strength and physical activity following HTX.

Methods
58 HTX-patients were addressed, of whom 52 (90%) patients participated in the study. Study visits were planned every 3 months from hospital discharge until 1 year of follow-up. 43 HTX-patients (67% male; age: 48 ± 14 years; BMI: 24 ± 4 kg/m²) fulfilled the study protocol. Outcome measures included functional exercise capacity (6MWD), peripheral strength (QF), respiratory muscle strength (MIP) and objectively measured physical activity (PAwalk, walking intensity (WI), PAsteps). All patients received physiotherapy at home during the first 6 weeks, as standard of care after thoracic surgery. After that, cardiac rehabilitation in a specialized center was started. Data were analyzed using repeated measures ANOVA, with Bonferroni test as post-hoc test.

Results
6MWD (+178 ± 17 meter), QF (+26 ± 4 Nm) and MIP (-32 ± 3 cmH2O) significantly improved over time (p &lt; 0.0001). Despite improvements in QF, peripheral muscle weakness was still present in 32% of patients 1 year post-HTX. A significant time effect in PA (PAwalk (+33 ± 7 minutes/day), WI (+0.036 ± 0.007 g) and PAsteps (+3711 ± 640 steps/day)) could be noticed (p &lt; 0.0001). Sedentary time did not significantly change during follow-up (p = 0.14). (Figure 1)

Conclusion
Functional exercise capacity and muscle strength gradually improve during 1 year after HTX. A considerable number of patients still present with peripheral muscle weakness. Despite improvements in PA, results remain below recommended health levels. Enrollment in a cardiac rehabilitation program, offering a combined exercise and PA intervention seems warranted to further enhance health outcomes in this patient population.
Abstract Figure 1
The relationship between clinical parameters and natriuretic peptides and quality of life in patients with heart failure with reduced ejection fraction
Authors: Sawczak F , Kukfisz A , Przytarska K , Szczechla M , Krysztofiak H , Kaluzna-Oleksy M , Migaj J , Straburzynska-Migaj E 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Heart failure (HF) patients are exposed to severe symptoms of the disease, fatal prognosis, rehospitalizations and low quality of life status. Furthermore, it was observed that more patients with HF would rather live better than longer.

Purpose
The aim of the study was to determine the relationship between clinical parameters, natriuretic peptides level and quality of life (QoL) in patients with heart failure with reduced ejection fraction.

Methods
111 patients hospitalized due to heart failure with reduced ejection fraction (HFrEF) were examined using WHOQOL-BREF questionnaire and divided into three groups of similar quantity due to their transformed score of somatic domain of QoL: first group with score &lt;45 - worst QoL (n = 33), second group with score between 45 and 55 (n = 42), and third with score &gt;55 - best QoL (n = 36). Then the group with highest scores, with best somatic QoL, was compared with those with lowest scores in respect of chosen clinical and biochemical parameters.

Results
Patients with the highest somatic domain score, comparing with the lowest, had significantly higher BMI (mean 29.8 ± 5.5 vs. 26.8 ± 5.7 kg/m2, p = 0.016), lower BNP level (465 vs. 967 pg/ml, median 275 vs. 690, p =0.005), higher LVEF (30.7 ± 12.0 vs. 23.9 ± 10.8%, p = 0.006), higher triglycerides level (2.02 ± 1.22 vs. 1.43 ± 0.76 mmol/l, p = 0.027) and iron level (17.8 ± 6.6 vs. 13.6 ± 5.5 µmol/l, p = 0.019) as well as transferrin saturation (28.0 ± 11.0 vs. 21.3 ± 8.9 %, p = 0.015). The percentage of patients with NYHA class I and II was higher in the group with the highest somatic domain score in comparison with the lowest (66.6% vs. 33.3% respectively, p = 0.034).

Conclusions
The somatic domain of WHOQOL-BREF in patients with HFrEF correlates with patients’ clinical state assessed with the NYHA class and BNP level. QoL status was not associated with age and gender which are depicted in the literature as the important aspects influencing QoL of the community.
Predictors of early and late re-hospitalization and mortality in non-ST elevation myocardial infarction
Authors: Santos M , Almeida I , Santos H , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Tavares J , Santos L , Almeida ML 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Regarding prognosis, acute coronary syndromes (ACS) are heterogeneous. Non-ST elevation myocardial infarction (NSTEMI) is a subtype of ACS. In-hospital (IH) and post-hospitalization (PH) risk stratification is crucial.

Objective
To identify predictors of IH and PH mortality (early and late), as well as predictors of early and late re-admission (RA) in our center population suffering NSTEMI, using real-life data.

Methods
Based on a single-center retrospective study, data collected from admissions between 1/01/2018 and 11/12/2019. Patients (pts) who survived the ACS and were discharged from the hospital were included. Concerning prognosis, we assessed 1-month M and RA (1mM and 1mRA), 6-month M and RA (6mM and 6mRA), 1-year M and RA (1yM and 1yRA).

Results
268 pts with ACS, 59.7% were males and mean age was 66.4 ± 12.5 years old. NSTEMI was the diagnosis in 66.4% and ST elevation myocardial infarction (STEMI) in 31%. Mean creatinine was 1.2 ± 1ml/min, mean sodium was 138 ± 3mmol/L, mean blood urea nitrogen (BUN) was 21 ± 12mg/dL and mean haemoglobin (Hb) was 13.6 ± 1.9g/dL. 88.2% of the pts presented in Killip-Kimball class (KKC) 1, 5.7% in KKC 2, 5.7% in KKC 3 and 0.4% in KKC IV; furthermore, 4.1% of the pts presented de novo AF. Concerning coronary artery disease, 250 were submitted to coronary angiography – 18.8% had no lesions or non-significant lesions (stenosis &lt;50%), 34.8% had one significant lesion, 23.2% had 2 significant lesions and 23.2% had 3 or more. Regarding left ventricle (LV) function, 70.5% of the pts had no LV dysfunction, 15.7% had mild LV impairment (LVI), 9.3% moderate LVI and 4.5% had severe LVI. 8.4% of the patients experienced IH complications, such as auriculoventricular block, heart failure, ventricular tachycardia, stroke, cardiorespiratory arrest and major haemorrhage, during hospitalization. 1mM rate was 1.9% and 1yM rate was 7.8%.
KKC (p = 0.001), BUN (p = 0.007), LV function (p= 0.001) and de novo AF (p = 0.46) were predictors of 1mM. Age (p = 0.004), KKC (p = 0.031), BUN (p = 0.002), sodium (p = 0.037), creatinine (p = 0.001), Hb (p = 0.003), LV function (p &lt; 0.001), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yM. Age (p = 0.010), male gender (p = 0.19), Hb (p = 0.031), de novo AF (p &lt; 0.001) and occurrence of IH complications (p = 0.001) were predictors of 1mRA. Age (p = 0.004), smoking (p = 0.040), hypertension (p = 0.040), glycemia at admission (p = 0.031), Hb (p = 0.004), LV function (p = 0.019), de novo AF (p &lt; 0.001) and occurrence of IH complications (p &lt; 0.001) were predictors of 1yRA.

Conclusion
This study suggests that de novo AF and occurrence of IH complications are very important prognosis factors regarding early and late mortality and readmission rates.
Acute Coronary Syndrome - reinfarction predictors and outcomes
Authors: Santos M , Santos H , Almeida I , Miranda H , Sa C , Chin J , Almeida S , Sousa C , Tavares J , Santos L , Almeida ML 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.

OnBehalf
on behalf of the Investigators of " Portuguese Registry of ACS "

Introduction
Reinfarction (RI) is a potential complication of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of RI in the setting of ACS.

Objective
To evaluate predictors and prognosis of RI in the setting of ACS.

Methods
Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) without data on previous cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts without RI; GB - pts with RI during hospitalization. Logistic regression and survival analysis were performed.

Results
Between 25718 pts with ACS, RI occurred in 223 (0.87%). Regarding epidemiological factors and past history, GB was older (70 ± 12 vs 67 ± 14, p &lt; 0.001), had higher rates of hypertension (77.4% vs 70.6%, p = 0.028), previous stroke (12.1% vs 7.2%, p = 0.005), peripheric arterial disease (10.0% vs 5.5%, p = 0.004) and chronic obstructive pulmonary disease (8.6% vs 4.4%, p = 0.003). GB had higher rates of non-ST-elevation myocardial infarction (MI) (54.3% vs 45.9%, p = 0.012) and GA had higher rates of ST-elevation MI (42.4% vs 35.9%, p = 0.049). The groups were similar regarding blood pressure (p = 0.285), heart rate (p = 0.796) and Killip-Kimball class at admission, but GB had higher levels of brain natriuretic peptide (392 vs 180, p = 0.005). GB had higher rates of multivessel disease (62.8% vs 51.6%, p = 0.002), left ventricle dysfunction (50.0% vs 39.1%, p = 0.002), higher needs of mechanical ventilation (6.3% and vs 1.9%, p &lt; 0.001) non-invasive ventilation (5.4% vs 1.7%, p &lt; 0.001). Logistic regression confirmed that peripheric arterial disease (p = 0.011, OR 1.93, CI 1.17-3.19), multivessel disease (p = 0.003, OR 1.69, CI 1.20-2.39) and lower left ventricle function (p &lt; 0.001, OR 2.42, CI 1.69-3.47) were predictors of RI in the setting of ACS. Event-free survival was similar between groups (p = 0.399).

Conclusion
RI in the setting of ACS was associated multivessel disease and left ventricle disfunction, however, 1-year prognosis was similar to pts who didn’t suffer RI.
Benefit of cardiac rehabilitation for elderly patients
Authors: Scherrenberg H , Scherrenberg M , Falter M , Intan-Goey V , Kaihara T , Dendale P 
Published: May 2021

Abstract

Funding Acknowledgements
Type of funding sources: None.
Benefit of cardiac rehabilitation for elderly patients

Background
Comprehensive cardiac rehabilitation (CR) is a class IA recommendation by European guidelines for all patients with ischemic heart disease (IHD). The risk profile of older IHD patients is often different from younger patients and there is less evidence available about the effects of CR. Therefore, it is still unclear if a one-size-fits-all centre-based CR focusing on the core components such as education, diet, risk reduction and optimal medication is as effective for elderly patients as for younger adults.

Methods
Patients with a revascularization for IHD who participated in at least 8 phase II center-based CR sessions between 2011–2014 were identified. A total of 294 patients were included in this study. The patients were divided in two groups: 0-64 years old and ≥ 65 years. The primary outcome was the incidence of major adverse cardiovascular events (MACE) during the 5-year follow-up. MACE is the composite of all-cause mortality, stroke and coronary artery revascularization.

Results
The medical records of 294 patients were retrospectively reviewed. Statistically significant baseline risk profile differences between the two groups were observed for the prevalence of current smokers (P &lt;0.001) and diabetes mellitus (P= 0.002). Furthermore, significant differences in blood pressure and lipid levels were present. No statistically significant differences between the two age groups were observed for 5-year coronary revascularizations (P = 0.794) and 5-year MACE (P = 0.221). Only significant differences between the age groups could be found in cardiovascular mortality (P = 0.023) and in all-cause mortality (P &lt; 0.001). However, the total years of life lost were lower in the group with patients older than 64 year (14 vs 32 years).

Conclusion
There is clear difference in cardiovascular risk profile between younger and older IHD patients that participate in CR. There was no significant difference in 5-year MACE between the two groups. These results underline the importance to not forget recommending CR to elderly patients.
Outcomes All (n = 294) &lt;65 y (n = 153) +65 y (n = 141) P-value 1-year coronary revascularization 11 (3.7%) 5 (3.3%) 6 (4.3%) 0.656 2-year coronary revascularization 23 (7.8%) 12 (7.8%) 11 (7.8%) 0.989 5-year coronary revascularization 36 (12.2%) 18 (11.8%) 18 (12.8%) 0.794 Cardiovascular mortality 8 (2.7%) 1 (6.5%) 7 (5%) 0.023 All-cause mortality 14 (4.8%) 2 (1.4%) 12 (8.5%) &lt;0.001 5-year MACE 49 (16.7%) 20 (13.1%) 29 (20.1%) 0.221