bluuebunny/crossref_metadata_2025_split huggingface dataset:
Proportionality of tricuspid regurgitation determines outcome in acute heart failure
Authors: Ashcroft E , Berrill M , John I , Baltabaeva A 
Published: October 2021

Abstract

Introduction
The impact of tricuspid regurgitation (TR) on outcomes in acute heart failure (AHF) incompletely understood. Often TR is considered secondary to right ventricular (RV) remodelling and dysfunction, and it is not clear if the regurgitant volume itself has additional adverse effects on outcome. We hypothesised a novel index, where TR regurgitant volumes (TRRV [ml]) are divided by the RV end-diastolic volumes (RVEDV [ml]) may help to identify patients at risk of poor outcome.

Purpose
To identify a cut-off for disproportionate TR and to assess its impact on survival in AHF.

Methods
418 consecutive patients admitted with AHF over 12 months to a single centre in the United Kingdom were recruited and followed up for 2 years. The endpoint was death from any cause. TR RV was calculated using the proximal isovelocity surface area method and right ventricular volumes using ellipsoid model. Receiver Operator Curve analyses were carried for the TRRV/RVEDV index. The optimum cut-off for prediction of 2-year mortality was estimated by identifying the sensitivity and specificity associated with the maximum Youden Index. These cut-offs were then used as a binary determinant of proportionate vs disproportionate TR.

Results
357/418 patients displayed TR (85.4%). The maximum Younden index associated criterion was &gt;44.3, which defined a binary determinant of disproportionate TR. There were no significant differences in baseline characteristics however patients with disproportionate TR were slightly older, predominantly female with chronic kidney disease, but a lower prevalence of diabetes. The mechanism of disproportionality in TR appears to be driven by increasing regurgitant volumes (79.2±47.2ml vs 22.9±19.5ml) and pulmonary artery pressures (50.7±16.4mmHg vs. 63.1±20.0mmHg) as RVEDV were similar between groups (113.5±48.8ml vs. 107.0±45.8ml). Patients with disproportionate TR were at greater risk of 2-year mortality (47.2%) compared to proportionate TR (36.6%) (HR 1.50; CI 1.03–2.15 [p=0.034]).

Conclusion
The disproportionate TR cut-off of 44.3ml-2 was able separate out those at greater risk. RVFAC, a traditional measurement of RV function was very similar between the two groups. This suggests rapid echo assessment may help to risk stratify patients presenting in AHF, aiding clinical decision making.

Funding Acknowledgement
Type of funding sources: None. Kaplan-Meier survival curveBaseline characteristics
Clinical features and long-term prognosis of patients with congestive heart failure taking tolvaptan: a comparison between preserved and reduced left ventricular ejection fraction
Authors: Seki T , Kubota Y , Matsuda J , Tokita Y , Iwasaki Y , Shimizu W 
Published: October 2021

Abstract

Background
There were few reports which investigated the clinical benefit of long-term use of tolvaptan (TLV) for heart failure (HF). The purpose of this study was to evaluate the long-term prognosis of patients administrated TLV for more than 1 year in the HF patients with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF).

Method
In a total of 591 consecutive patients who were admitted to our hospital and administered TLV for HF between 2011 and 2018, we retrospectively enrolled 147 patients who were administered TLV for more than 1 year. The patients were classified into 2 groups, the HFpEF group (n=77, 52.4%) and the HFrEF group (n=70, 47.6%), and clinical backgrounds and long-term prognosis were examined. Furthermore, we performed stratified analysis based on the response to TLV defined by urine osmolality (The responder group n=40, the non-responder group n=52).

Results
The HFpEF group was significantly older (77.7±9.2 vs. 71.3±11.5 years, P&lt;0.01) and included more female (41.6 vs. 21.4%, P&lt;0.01) compared with the HFrEF group. Other baseline characteristics were not different between the two groups. During the average 2.7 years follow up, the HFpEF group showed significantly lower all-cause mortality and cardiovascular mortality compared to the HFrEF group (24.7 vs. 38.6%, Log-Rank P=0.014, 13.0 vs. 25.7%, Log-Rank P=0.007, respectively). Univariate analysis revealed that male, HFpEF, serum creatinine changes from baseline (ΔCre) were the factors correlated with all-cause mortality (HR 2.12, 95% CI 1.02 – 4.40, P=0.045, HR 0.48, 95% CI 0.26 - 0.87, P=0.016 and HR 1.50, 95% CI 1.00 - 2.24, P=0.049, respectively). According to multivariate analysis, HFpEF was the independent influencing factor of all-cause mortality (HR 0.44, 95% CI 0.23 - 0.86, P=0.017). Stratified analysis revealed that in the non-responder group all-cause mortality was significantly lower in the HFpEF group than in the HFrEF group (24.2% vs 48.3%, P=0.049).

Conclusion
Long-term administration of TLV maybe more beneficial for HFpEF compared with HFrEF. This tendency was remarkable at non-responder group.

Funding Acknowledgement
Type of funding sources: None.
Targeted delivery controlled release of hepatic growth factor and insulin-like growth factor-1 improves left ventricular repair in a porcine model of myocardial ischemia reperfusion injury
Authors: Wu M , Claus P , De Buck S , Veltman D , Gillijns H , Holemans P , Pokreisz P , Caluwe E , Estefania E , Cohen S , Prosper F , Pelacho B , Janssens S 
Published: October 2021

Abstract

Introduction
Nanomedicine offers great potential for treatment of cardiovascular disease. We tested whether direct intramyocardial (IM) injection of pro-angiogenic hepatocyte growth factor (HGF) and pro-myogenic insulin-like growth factor (IGF-1) encapsulated in Alginate-Sulfate nanoparticles (AlgS-NP) enhances myocardial retention, controlled release and improves myocardial repair in a porcine ischemia-reperfusion model.

Methods
Bioactivity of HGF/IGF, released from AlgS-NP, was determined by cell proliferation assays in vitro. Myocardial infarction (MI) was induced by 75min balloon occlusion of the mid-LAD followed by reperfusion. After 1w, pigs (n=12) with marked LV dysfunction (EF&lt;45%) were randomized to fusion imaging-guided IM injections of 8 mg Cy5-labelled AlgS-NP loaded with 200μg HGF and 200μg IGF-1 (GF) or with phosphate-buffered saline (CON) using the MYOSTAR injection catheter. AlgS-NP retention after IM or intracoronary (IC) injection was determined by measuring Cy5 plasma levels. At 8w, treatment effect was evaluated using in vivo magnetic resonance imaging and coronary physiological measurements, and via post-mortem analysis of myocardial fibrosis and cardiomyocyte circumference.

Results
We confirmed the bioactivity of the AlgS-NP-released GF in C2C12 and HUVEC cell proliferation assays after 72h culture, being similar to the free GF (Fig. A). AlgS-NP retention was tested in a pig model, 1w after MI. Ejection fraction (EF) was 37±5% (range 27–45%) and infarct size (IS)/LVmass 24±6% (range 19–38%). AlgS-NP retention was better after IM delivery than after IC infusion with plasma Cy5 levels at 30 min after treatment indicating 5% systemic leakage for IM vs. 20% for IC. After 8w, IS/LVmass decreased 8% in GF-treated pigs vs. 3% in CON (P=0.03, Fig. B) and was associated with preserved myocardial blood flow during hyperemia in the infarct (P=0.036) and peri-infarct (PI) zones (P=0.008), increased coronary flow reserve (P=0.05) and decreased index of microcirculatory resistance (P=0.02). LVEF significantly increased in GF-treated pigs (+6±2% vs. −1±1% in CON, P=0.02, Fig. C), and was accompanied by significantly reduced fibrosis (P=0.01) and increased hypertrophy of cardiomyocyte (P=0.03) in the PI zone.

Conclusions
IM injection of AlgS-NP-encapsulated HGF and IGF-1 to the ischemic myocardium significantly improves LV repair, and offers the prospect of innovative treatment for patients with refractory ischemic heart disease.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): EuroNanoMed II Figure AFigure B and C
Effects of aerobic physical rehabilitation on muscle fiber metabolism in patients with severe heart failure
Authors: Galenko V.L , Lelyavina T.A , Dzeboeva A.Y , Yukina G.Y , Bortsova M.A , Sitnikova M.Y 
Published: October 2021

Abstract

Purpose
To evaluate changes of functional state and metabolism of skeletal muscle fiber (MF) after aerobic physical rehabilitation (PR), based on original method; to study relationship between clinical data dynamics and indicators of skeletal muscle metabolism after PR.

Methods
100 patients; heart failure (HF) with reduced ejection fraction (HFrEF), NYHA III, mean age 52±5,2 years, ejection fraction (EF) 27,3±4,2%, BMI 23,5±2,8 kg/m2. Before inclusion in PR program cardiopulmonary exercising test (CPET), echocardiography (EchoCG), quality of life (QOL), exercise tolerance (ET) were estimated. Physical training intensity was based on lactate threshold achievement during CPET. PR efficiency was estimated on the basis of peak oxygen uptake (VO2peak), EF, QOL and ET dynamics after 6 months PR. Shin muscle biopsy was performed at baseline and after 3–6 months PR. In muscle samples activity of alkaline phosphatase (AP), lactate dehydrogenase (LDH) and succinate dehydrogenase (SDG) was evaluated with plag-method. Data were statistically processed using software package “Statistika, 9.0”.

Results
After 6 months of training EF increased by 10,5±2,3%, ET increased by 9,7±0,5 points (p1,2 &lt;0,05), QOL changed by 24,8±3,5 points (significant regression of symptoms), VO2peak increased by 5,2±0,5 ml/min/kg (p3,4 &lt;0,05). MF diameter (dMF) after PR slightly decreased in 6 patients, in 2 patients it did not change. After 3–6 months of training AP activity increased by 24,2% (p&lt;0,05); LDH activity in glycolytic MF decreased by 24,4%, in oxidative MF it decreased by 6,0% only (p1 &lt;0,05, p2&gt;0,05). SDG activity in glycolytic MF increased by 20%, in oxidative MF it increased by 30% (p1 &lt;0,05, p2&lt;0,05). There was a positive relationship between heart failure functional class dynamics and dMF (r=0,4, p=0,05), increase in CPET parameters was associated with AP activity (r=0,5, p=0,05).

Conclusion
Aerobic physical rehabilitation in stable HF pts, selected on the basis of LT achievement, was effective in improving values of EF, QOL, VO2peak and ET. After 3–6 months PR dMF slightly decreased;
Participating in the PR program decreased LDH activity in both oxidative and glycolytic muscle fibers; it also increased AP and SDG activity significantly. This may indicate an increase in oxidative metabolism activity and decrease in MF edema, improvement in skeletal muscles microcirculation.

Funding Acknowledgement
Type of funding sources: None.
Right bundle branch block and male sex may help predict appropriate ICD therapies in patients with non-ischemic dilated cardiomyopathy and a prophylactic implantable cardioverter defibrillator
Authors: Amores Luque M , Jimenez-Blanco Bravo M , Parra Esteban C , Alonso Salinas G.L , Alvarez Garcia J , Fernandez Lozano I , Del Prado Diaz S , Toquero Ramos J , Zamorano Gomez J.L , Castro Urda V 
Published: October 2021

Abstract

Background
Previous studies have shown that prophylactic implantable cardioverter-defibrillators (ICD) in patients with symptomatic severe systolic dysfunction reduce all-cause mortality. However, their benefit in patients with severe systolic dysfunction of non-ischemic origin is not so clear, and is currently under debate.

Methods/Aim
We retrospectively reviewed all consecutive patients with nonischemic dilated cardiomyopathy (NICM) who underwent prophylactic ICD implantation between 2008 and 2020 in two tertiary centers. Our main goal was to identify predictors of appropriate ICD therapies (ATP and/or shocks) in this cohort of patients.

Results
A total of 224 patients were included, median age 62.7 years, 73.7% men. During a median follow-up of 51 months, 61 patients (27.2%) required appropriate ICD intervention, 7 patients (3.1%) presented inappropriate shocks and 11 (4.9%) had device infection.
Patients that received appropriate ICD therapies, as compared to those who did not, were more frequently men (86.9% vs 68.7%, p=0.006) and were significantly younger (median age 58.7 years, IQR 53.0–64.8 vs 63.7, IQR 57.0–69.8; p=0.02). Left ventricular end diastolic volume (LV-EDV) and left ventricular end systolic volume (LV-ESV) were both significantly higher in this subgroup of patients (median LVEDV 100 ml/m2 vs 86, p=0.0106; median LVESV 72.2 ml/m2 vs 60.9, p=0.0467). A trend towards lower LVEF was also noted, but it did not reach statistical significance (26% vs 29%, p=0.077). Regarding ECG previous to implant, patients that required ICD intervention presented more frequently complete right bundle branch block (RBBB) (14.8% vs 4.3%, p=0.007). On the other hand, left bundle branch block (LBBB) was more frequent in those patients who did not receive ICD intervention during follow-up (47.2% vs 26.2%, p=0.005). Table 1 summarizes baseline characteristics and results.
In a multivariate Cox regression analysis, RBBB (HR 3.9, CI 95% 1.9–8.0, p&lt;0.001) and male sex (HR 2.38, CI 95% 1.07–5.28, p=0.034) were identified as independent predictors of appropriate ICD therapies (Figure 2).

Conclusion
RBBB and male sex may help identify patients with NICM at high-risk of ventricular arrhythmias requiring ICD intervention.

Funding Acknowledgement
Type of funding sources: None. Baseline characteristics and resultsKaplan-Meier curves
The development of a new, simple electrocardiographic method for the estimation of the latest activated left ventricular site
Authors: Vereckei A , Katona G 
Published: October 2021

Abstract

Background
Current cardiac resynchronization therapy (CRT) works by pacing the latest activated left ventricular (LV) site. The estimation of the location of the latest activated LV site (LALVS) may be important to determine the optimal position of the LV electrode during CRT or to predict the patient response to the current CRT technique devised to pace the LALVS usually present in patients with left bundle branch block (LBBB) pattern.

Methods
We used a modified 12-lead ECG algorithm originally devised and used by other authors* for a different purpose, to identify the segment of origin of ventricular tachycardia in the 16-segment American Heart Association LV model by analyzing the QRS axis in the limb and chest leads. We hypothesized that modifying this ECG algorithm by using the secondary ST vector axis instead of the QRS axis in the limb and chest leads, we can apply this ECG method to estimate the LALVS instead of the site of origin of the ventricular tachycardia. The resultant secondary ST vector is directed 180o away from the LALVS. Using this ECG method we determined the LALVS in 22 patients with LBBB and 20 patients with nonspecific intraventricular conduction disturbance (NICD) patterns and heart failure. To validate the ECG method, we also estimated the LALVS by echocardiography using 3D parametric imaging and 2D speckle tracking.

Results
The LALVS determined by the electrocardiographic method and echocardiogrpahy in the 16-segment model matched (was in the same or adjacent segment) in 38/42 (90.5%) patients and among these patients complete matching (the LALVSs were in the same segment) was found in 16/38 (42%) and partial matching (the LALVSs were in adjacent segments) in 22/38 (58%) patients. When the LBBB and NICD groups were separated to patients with ≥150 ms and &lt;150 ms QRS duration subgroups, the LALVSs of the ≥150 ms subgroup were almost exclusively in the anterolateral (or anterior) or inferolateral areas and those of the &lt;150 ms subgroup were in the above mentioned areas or sometimes at other sites located remote from these areas.

Conclusions
The novel, simple surface electrocardiographic method could as reliably estimate the approximate location of LALVS as echocardiography. The possible explanation for the effectivity of CRT in patients with sinus rhythm with intraventricular conduction disturbance and ≥150 ms QRS duration is that their LALVS is at the same most distant areas (anterolateral, anterior, inferolateral) from the initial septal activation site where the LV electrodes are positioned during application of the current CRT technique.

Funding Acknowledgement
Type of funding sources: None.
Trends, risk factors and prognostic implications of postoperative stroke after heart transplantation: an analysis of the UNOS database
Authors: Briasoulis A , Doulamis I , Kampaktsis P , Alvarez P 
Published: October 2021

Abstract

Background
Post-operative stroke increases morbidity and mortality after cardiac surgery. Data on characteristics and outcomes of stroke after heart transplantation (HT) are limited.

Methods
We conducted a retrospective analysis of the UNOS database from 2009 to 2020 to identify adults who developed stroke after orthotropic HT. HT recipients were divided according to the presence or absence of postoperative stroke. The primary endpoint was all-cause mortality after HT.

Results
A total of 25,015 HT recipients were analyzed, including 719 (2.9%) patients who suffered perioperative stroke. The rates of stroke increased from 2.1% in 2009 to 3.7% in 2019 and the risk of stroke was higher after the implantation of the new allocation system (odds ratio 1.29, 1.29, 95% Confidence Intervals [CI] 1.06–1.56, p=0.01). HT recipients with postoperative stroke were older (p=0.008), with higher rates of prior cerebrovascular accident (CVA) (p=0.004), prior cardiac surgery (p&lt;0.001), longer waitlist time (p=0.04), higher rates of extracorporeal membrane oxygenation support (ECMO) (p&lt;0.001), left ventricular assist devices (LVAD) (p&lt;0.001), mechanical ventilation (p=0.003) and longer ischemic time (p&lt;0.001). After multivariable adjustment for recipient and donor characteristics, age, prior cardiac surgery, CVA, support with LVAD, ECMO, ischemic time and mechanical ventilation at the time of HT were independent predictors of postoperative stroke. Stroke was associated with increased risk of 30-day and all-cause mortality after HT (hazard ratio [HR] 1.49, CI 1.12–1.99, p=0.007).

Conclusion
Perioperative stroke after HT is infrequent but associated with higher mortality. Redo sternotomy, LVAD and ECMO support at HT are among the risk factors identified.

Funding Acknowledgement
Type of funding sources: None. Risk factors for stroke
The surgical management of heart failure: heart transplantation in the era of SARS-CoV-2 pandemic
Authors: Malyszek J , Jasinska M , Zembala M , Ratman K , Krol B , Tkocz K , Pelar K , Sybila P , Pajor M , Nawrat Z 
Published: October 2021

Abstract

Purpose
End-stage heart failure (HF) is a major global clinical problem with a growing number of patients worldwide. Heart transplantation (HTx) and mechanical circulatory support (MCS) represent the two most effective procedural options for the treatment of end-stage HF. HTx remains the treatment of choice in patients who reach maximal medical therapy, but, remain incapacitated by their symptoms.
The COVID-19 pandemic caused by SARS-CoV-2 has significantly affected the delivery of medical care across all specialties, therefore, it is not a surprise that the number of HTx has drastically diminished worldwide during the pandemic.
We developed in our Center of Heart Diseases effective safety measures and team approach in order to perform HTx with excellent outcomes.

Methods
All patients with reduced ejection fraction, heart failure at presentation and had been adequately investigated had been evaluated by a multidisciplinary team and when appropriate entered into a waiting list for HTx.

Results
From March2020 to March 2021, 96 patients underwent orthotopic HTx. The age range was 33 - 66 yrs and a median of 54 yr. Both donor and recipient were tested for SARS-CoV-2 within 48 hrs of the procedure, and none tested positive. All recipients were regularly tested following the procedure, too, and none were positive. 53 patients with INTERMACS 4 class have been treated, 31 with INTERMACS 3 class and 11 patients with INTERMACS 2. Only one patient with INTERMACS 1 underwent HTx. 6 (10%) patients died within the first 30 days following HTx.
All staff caring for those patients were screened for SARS-CoV-2 at regular intervals. There was liberal use of PPE at all stages of the care of the patients, with strict hand hygiene.
All surviving patients were subjected to the normal protocol of post-operative management in terms of immunosuppression and other medications.

Conclusion
Heart transplantation remains the treatment of choice for advanced heart failure. About 85% of heart transplant patients survive one year following the procedure thus giving them a better quality of life. We have shown that successful heart transplantation may be performed during the SARS-CoV-2 pandemic.

Funding Acknowledgement
Type of funding sources: None.
Twenty-year temporal and regional trends in heart transplantation in Europe: results from the Global Observatory on Donation and Transplantation (GODT)
Authors: Manla Y , Al Badarin F.J , Soliman M , Gobolos L , Alsindi F , Bader F 
Published: October 2021

Abstract

Introduction
Heart transplant (HT) remains the only cure for patients with advanced heart failure. However, limited supply of donors continues to be the main obstacle to growing transplant programs around the world. Since population changes are not uniform, describing temporal trends in availability of donors and in number of transplanted hearts will provide better understanding of regional variations in organ availability and allocation.

Purpose
We aim to evaluate temporal and regional trends in number of brain-dead donors (BDDs) and its association with the number of heart transplants (HTs) in Europe between 2000 and 2019.

Methods
Global Observatory on Donation and Transplantation (GODT) represents the world's most comprehensive source of data on organ donation and transplantation. Available data were collected for all European countries for the years (2000–2019) except for the year 2005. Geographical classification (north, west, central, south) was made according to EuroVoc definition. Trends of HTs and BDDs were assessed using Joinpoint Software of the National Cancer Institute to calculate the annual percentage change (APC) and reported as per million population (PMP). The linear correlation coefficient was assessed using R studio.

Results
Over the past two decades, there was a 35% increase in HTs PMP rate in Europe from the year 2000 to 2019 with an APC of 1.4% (95% CI [1.1–1.7], P&lt;.0001). This change was more pronounced in Central Europe, where HTs PMP rate increased from 0.65 in 2000 to 2.93 in 2019 (APC 9.9% (95% CI [8.1–11.8], P&lt;.0001)) and in Northern Europe, where HTs PMP rate increased from 2.97 in 2000 to 5.18 in 2019 (APC 2.7% (95% CI [1.8–3.7], P&lt;.0001)) (Figure 1). Despite the increase in BDDs in Europe between 2000–2019 (from 3.62 to 12.25 donors PMP) (Figure 2), the association between increased BDDs and HTs varied between regions, with a very strong association in Central Europe (r=0.95, P&lt;0.0001) and strong correlation in Northern Europe (r=0.64, P=0.003). However, positive correlation between BDDs and HTs was not seen in Southern or Western Europe (r=−0.52, p-value=0.02, r=0.02, p-value=0.94, respectively).

Conclusion
The number of BDDs has increased in Europe in the past two decades with a concomitant increase in HT volumes. A regional variation in the relationship between the number of BDDs and HTs was observed among European subregions, such that it was most pronounced in Central Europe. Understanding the reasons underlying these disparities can potentially inform improvement in organ allocation systems throughout Europe.

Funding Acknowledgement
Type of funding sources: None.