bluuebunny/crossref_metadata_2025_split huggingface dataset:
Beta-blocker could show the prognostic impact in heart failure patients even on the regular hemodialysis
Authors: Kishihara M , Kentaro J , Takuma T , Takuro A , Shota S , Ayano Y , Shonosuke W , Yuichiro M , Nobuhisa H 
Published: October 2021

Abstract

Background
β-blockers are recommended as standard medications for patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, this favorable prognostic effect of β-blockers has not been fully validated in patients receiving regular hemodialysis. Indeed, prior clinical trials have generally excluded such very high-risk population for adverse cardiovascular events. Main reasons for that are the limited number of regular hemodialysis patients in the Western nations, and too high rates of clinical events.

Purpose
This study aimed to clarify the prognostic benefit of β-blocker in patients on regular hemodialysis who were hospitalized due to HF.

Methods
This observational study included 1,930 consecutive patients who were hospitalized for worsening of HF and discharged alive from 2013 to 2019. Of them, 151 patients who underwent regular hemodialysis were ultimately analyzed. They were divided into 2 groups depending on the prescription of β-blocker at the discharge; β-blocker group (n=115) and No-β-blocker group (n=36). The primary endpoint of this study was a composite of death from any cause and rehospitalization due to HF.

Results
During the observation period with 501 days of median follow-up (IQR: 197–954 days), the primary endpoint was occurred in 45 patients (39%) who were receiving β-blockers, while in 24 patients (67%) who were not. Kaplan-Meier analysis showed a significantly lower rate of the primary endpoint in patients in the β-blocker group (Log-rank, p&lt;0.001, Figure). After the adjustment for age, sex, LVEF, systolic blood pressure, heart rate and atrial fibrillation, the administration of β-blocker was still an independent predictor for the primary endpoint in patients who underwent regular hemodialysis (hazard ratio; 0.46, 95% confidence interval; 0.26–0.82). Further analysis each for the population with reduced LVEF (&lt;45%) and preserved LVEF (&gt;45%) showed that the main result of the current study was consistent with that in the reduced LVEF group (Log-rank, p=0.005), but was diminished in the preserved LVEF group (p=0.13).

Conclusion
The prescription of β-blocker at discharge in HF patients with regular hemodialysis was associated with lower risk of adverse cardiovascular events, mainly in the patients with reduced LVEF. From the findings of our study, we should consider the administration of β-blockers in HF patients, even they are on the regular hemodialysis.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Absence of exercise capacity improvement after in-hospital short-term cardiac rehabilitation is associated with long-term clinical outcome in heart failure patients
Authors: Fukushima T , Fukui J , Maemura K 
Published: October 2021

Abstract

Background
Previous studies suggest Cardiac rehabilitation (CR) improve exercise capacity and decline mortality in heart failure (HF) patients. However, some studies show there are HF patients who do not improve exercise capacity by CR and these patients have a higher risk of adverse events in long-term clinical outcome. We investigated whether absence of exercise capacity improvement after in-hospital short-term CR also has adverse effect in long-term clinical outcome.

Methods
In this retrospective study, 130 HF patients who underwent two weeks in-hospital CR after received standardized HF treatment between July 2014 and August 2020 were included. Improvement in exercise capacity was assessed by change in peak oxygen consumption (delta-Peak VO2) measured at 1st and 14th day of CR by cardiopulmonary test. The median delta-PeakVO2 was 1.3 ml·kg-1·min-1. Patients were classified as responder if they demonstrated delta-PeakVO2 ≥1.3 ml·kg-1·min-1 and as non-responder if they demonstrated delta-PeakVO2 &lt;1.3ml·kg-1·min-1. MeanΩ follow-up was 1236 days. The primary outcome was all-cause death.

Result
63 patients (48.4%) were classified as non-responder. Non-responders were older (75.5±10.6 vs 70.8±11.0, P=0.01) and lower estimated glomerular filtration rate (eGFR) (49.7±19.4 vs 57.9±19.2) and lower albumin (3.5±0.5 vs 3.7±0.3 g/dL, P=0.04) than responders. Transtricuspid pressure gradient (TRPG) measured by transthoracic echocardiography was also higher in non-responders (28.5±10.9 vs 22.7±6.3). Predictor of non-responders were TRPG (OR = 1.1, 95% CI 1.02–1.26) and albumin (OR =0.04, 95% CI: 0.003–0.40). In multivariate analysis including delta-PeakVO2 &lt;1.3 ml·kg-1·min-1 (non-responder), age &gt;75, male gender, PeakVO2 at 1st day of CR, body mass index (BMI), left ventricular ejection fraction measured by transthoracic echocardiography, medication of β-blockers showed that delta-PeakVO2 &lt;1.3 ml·kg-1·min-1 (HR =2.8, 95% CI 1.0–7.5), age&gt;75 (HR11.2, 95% CI 2.1–60.1), BMI (HR =0.8, 95% CI 0.6–0.96) were associated with all-cause death.

Conclusion
The absence of exercise capacity improvement after in-hospital short-term CR was the risk of all-cause death. Especially, the HF patients with higher TRPG and lower albumin have a higher probability of becoming a non-responder.

Funding Acknowledgement
Type of funding sources: None.
Improvement of exercise tests and reduction of heart failure biomarkers in short term follow up after comprehensive rehabilitation program of patients with implanted LVAD
Authors: Chwyczko T , Smolis-Bak E , Zalucka L , Segiet-Swiecicka A , Piotrowicz E , Was J , Niedolistek M , Kowalik I , Furmanek M , Sobieszczanska-Malek M , Zielinski T , Szymanski J , Kusmierczyk M , Piotrowicz R , Dabrowski R ,   RH-ROT
Published: October 2021

Abstract

Background
There is increasing recognition of the importance of rehabilitating patients after LVAD implantation. The novel method of comprehensive rehabilitation starting directly after LVAD implantation was designed for our LVAD patients population.

Aim of the study
The study aimed to determine, if novel rehabilitation program improves functional and biochemical parameters in patients after recent LVAD implantation.

Study group
37 recent LVAD (22 Heart Mate III, 15 HeartWare) recipients (19–67, mean 58.7 years, 35 men) participated in specially designed rehabilitation program. The program included 4–5 weeks of sationary rehabilitation: supervised endurance training on cycloergometer (5 times per week), resistance training, general fitness exercises with elements of equivalent and coordination exercises (every day). It was followed by individual exercises performed at home. At the beginning and at the end of rehabilitation program the patients performed 6 minute walking test (6MWT), cardiopulmonary exercise test (CPET). Following prognostic biomarkers of heart failure: NT-proBNP, galectin-3 and ST2 were also measured.

Results
See table 1. Increase of 6MWT distance, higher maximal workload, peak VO2 and upward shift of anaerobic threshold in CPET were observed in all patients. Significant reductions of NTproBNP, ST2 and galectin-3 levels were observed. There were no major adverse events during rehabilitation.

Conclusions
Comprehensive novel rehabilitation in LVAD recipients is safe and results in significant improvement of functional tests and biomarkers of heart failure.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Center for Research and Development: National grant - STRATEGMED II,
Right ventricular reverse remodeling assessed by echocardiography as a new goal-oriented treatment strategy in PAH patients
Authors: Fauvel C , Raitiere O , Si-Belkacem N , Viacroze C , Artaud-Macari E , Schleifer D , Dominique S , Bauer F 
Published: October 2021

Abstract

Background
While in heart failure with reduced ejection fraction, left ventricular reverse remodeling assessed by transthoracic echocardiography (TTE) is associated with better prognosis, right ventricular reverse remodeling (RVRR) was less investigated in pulmonary arterial hypertension (PAH)

Purpose
We aimed to investigate whether RVVR assessed by echocardiography could help to stratify PAH patient's prognosis.

Methods
Between 2002 and 2019, all consecutive PAH patients were included, treated and followed in a single PAH center in accordance with the current ESC/ERS guidelines. In addition to regular risk stratification parameters, we measured several echocardiographic RV systolic function and size parameters, including tricuspid annular plane systolic excursion (TAPSE, mm) or RV-end diastolic area (cm2) from apical-4 chamber view both at baseline, 1-year of follow-up as well as their change. Primary composite outcome was three-year transplant-free survival and death from all cause from the 1-year evaluation. Conditional inference trees were used to determine which TTE parameters and cutoffs values were associated with primary outcome from hierarchy of multiple covariates in multivariable Cox regression analysis. Kaplan-Meier curves were then drawn and compared with log-rank test.

Results
126 incident PAH patients were included (63% female, mean age 59±18 yo), mainly due to connectivite-tissue disease and idiopathic PAH (26% and 22% respectively). At baseline, mean pulmonary arterial pressure was 42 (33, 52) mmHg. At 1-y follow-up under pulmonary vasodilation therapy, NYHA (p&lt;0.01), NTproBNP (p&lt;0.01), mean pulmonary arterial pressure (p&lt;0.01) and cardiac index (p&lt;0.01) were significantly improved compared to baseline. Conditional inference trees showed that 1-year TAPSE gain &gt;1 mm and 1-year RV end-diastolic area decreased &gt;2 cm2 were associated with 3-year transplant-free survival in multivariable Cox regression analysis (HR=0.23, 95% CI [0.08–0.61] p=0,0035, HR=0.34, 95% CI [0.12–0.94], p=0.038). Simple score from 0 (absence of RVRR), 1 (partial RVRR) and 2 (complete RVRR), describing the number of TTE parameters reach at 1-year was then investigated. Patients with complete RVRR depicted better transplant-free survival than partial or absence of RVRR, log-rank p&lt;0.001 (figure).

Conclusion
Complete reverse remodeling from right ventricular size and function could represent a new goal-oriented treatment strategy in PAH patients.

Funding Acknowledgement
Type of funding sources: None. RVRR survival curves
10-year survival in patients undergoing cardiac resynchronization therapy
Authors: Mazurek M , Jedrzejczyk-Patej E , Sokal A , Gumprecht J , Kotalczyk A , Szulik M , Pruszkowska P , Kowalski O , Lenarczyk R , Kalarus Z 
Published: October 2021

Abstract

Background
Advanced heart failure with reduced ejection fraction (HFrEF) is associated with poor prognosis. Cardiac resynchronization therapy (CRT) is an effective method of treatment for advanced HFrEF to reduce HF hospitalizations and mortality. Nonetheless, very long-term observation of HF patients undergoing CRT implantation is scarce.

Aim
To assess very long-term survival (≥10 years) and predictors of shorter survival (death within 10 years from CRT implantation).

Methods
We screened a large dataset of CRT population from a tertiary care university hospital comprising consecutive HF patients implanted with CRT from 2002 through 2019 to select those who were alive ≥10 years and those who died within 10 years since device implantation. We analyzed various patients' baseline, clinical and procedural characteristics and sought for predictors of mortality within 10 years from CRT implantation.

Results
Of 1059 CRT patients, 143 (13.5%) were alive ≥10 years since CRT implantation. On multivariable regression analysis the independent predictors for all-cause death up to 10 years from CRT implantation were as follows: age, HR 1.02, 95% CI 1.01–1.31; male sex, 1.27, 95% CI 1.01–1.60; primary prevention of sudden cardiac death (SCD), HR 0.72, 95% CI 0.58–0.89; ischemic cardiomyopathy, HR 1.41, 95% CI 1.76–1.70; NYHA class at implantation, HR 1.38, 95% CI 1.17–1.62; baseline left ventricle ejection fraction (EF), HR 0.97, 95% CI 0.96–0.98; severe mitral regurgitation, HR 1.38; 95% CI 1.08–1.75; baseline NT-proBNP concentration, HR 1.00, 95% CI 1.00–1.00; and creatinine level, HR 1.00, 95% CI 1.00–1.01.

Conclusions
In a real-life patient population with CRT only 13.5% survived over 10 years since device implantation. Independent predictors for death within 10 years since CRT implantation were older age, male sex, secondary prevention of SCD, ischemic and more advanced heart failure along with renal impairment.

Funding Acknowledgement
Type of funding sources: None.
The effect of prolonged Intraaortic ballon pump (IABP) support on right ventricular function in end-stage heart failure
Authors: Bonios M.J , Armenis I , Kogerakis N , Thodou A , Fragkoulis S , Gkouziouta A , Leontiadis E , Vartela V , Georgiadou P , Zarkalis D , Tsiapras D , Koliopoulou A , Chamogeorgakis T , Drakos S.G , Adamopoulos S 
Published: October 2021

Abstract

Introduction
Right Ventricular (RV) function has prognostic implications in end-stage heart failure (ESHF) patients. RV failure following Left Ventricular Assist Device (LVAD) implantation increases morbidity and mortality. Achieving optimal RV function before LVAD implantation is of paramount importance.

Purpose
Purpose was to investigate the effect of Intra-aortic Balloon Pump (IABP) on RV function optimization in patients with bi-ventricular ESHF.

Methods
ESHF patients with poor RV function, presenting with acutely decompensated heart failure resistant to inotropes/vasopressors, thus requiring IABP for stabilization, were prospectively enrolled. Serum biochemistry, echocardiography and invasive hemodynamics were applied and eligibility for LVAD according to RV function was determined on the basis of pre-specified criteria (Right atrium Pressure (RAP) &lt;12mmHg, Pulmonary Artery Pulsatility index (PAPi) &gt;1.85, RAP/Pulmonary Capillary Wedge Pressure (PCWP) &lt;0.67, RV strain &lt;−14%). LV and RV tissue was harvested during LVAD or bi-ventricular mechanical circulatory implantation or at the time of heart transplantation. Fibrosis of the myocardial tissue was quantified.

Results
Sixteen patients aged 38±14 years were enrolled. Duration of IABP support was 62±50 (3–180) days. Three patients deteriorated requiring additional mechanical circulatory support. Two patients were stabilized without RV function improvement. In the remaining 11 patients, RV improved and fulfilled LVAD eligibility criteria (IABP responders); RA and RA/PCWP decreased from 18±6 to 10±4mmHg (p=0.0001) and from 0.60±0.19 to 0.42±0.11 (p=0.011) respectively. PAPi and RV strain improved from 1.46±0.65 to 3.20±0.58 (p=0.0001) and from −12.9±3.4% to −18.7±1.7% (p=0.0001) respectively. Significantly lower baseline NTproBNP and total bilirubin values were observed in the responders group. Six patients finally received LVAD and none suffered RV failure post-operatively (the remaining 5 were successfully transplanted). RV fibrosis correlated with post-IABP NTproBNP (r=0.91, p=0.001), total bilirubin (r=0.79, p=0.011), RAP (r=0.78, p=0.014), PAPi (r=−0.69, p=0.040), RAP/PCWP (r=0.74, p=0.022) and LV fibrosis (r=0.77, p=0.016), but not with baseline (pre-IABP) parameters.

Conclusions
Prolonged IABP support contributes to partial RV function recovery in patients with ESHF and bi-ventricular failure, thus leading to eligibility for LVAD implantation. RV fibrosis may predict RV response to IABP and post-IABP eligibility for LVAD.

Funding Acknowledgement
Type of funding sources: None.
Third generation continuous flow left ventricular assist devices; a comparative outcome analysis by device type
Authors: Mihalj M , Heinisch P.P , Schober P , Dobner S , Fuerholz M , Martinelli M , Hugi-Mayr B , De By T.M.M.H , Mohacsi P , Schefold J.C , Luedi M.M , Kadner A , Carrel T , Hunziker L , Reineke D ,   LVAD Unit University Hospital Bern
Published: October 2021

Abstract

Background
Continuous-flow left ventricular assist devices (CF-LVADs) have become a standard of care in end-stage heart failure (HF). Device-related complications remain high. Limited data exists comparing outcomes of the HeartMate 3 (HM3) and the HeartWare HVAD (HW). We aimed to analyze HM3 and HW devices implanted over the past 10 years with a focus on long-term clinical outcomes of respective patients.

Methods
Investigator-initiated comparative, retrospective observational analysis of all patients who underwent primary implantation of a centrifugal CF-LVAD at our tertiary care academic center between January 2010 and December 2020. Data derived from a prospective registry, and included all patients receiving a HM3 or HW device. Primary endpoint was overall (all-cause) mortality and heart transplantation. Secondary endpoints included device-related major adverse cardiac and cerebrovascular events (MACCE), as well right heart failure (RHF), gastrointestinal (GI) bleeding, driveline infections, and surgical re-interventions.

Results
Out of 106 primary CF-LVAD implantations, 36 (34%) received HM3 and 70 (66%) received HW. Median follow-up time was 1.48 years [interquartile range 0.67, 2.41] and did not differ between devices (p=0.739). HM3 was more often implanted in men (91.7% vs. 72.9%, p=0.024), patients were older (median 61 years [54, 66.5] vs. 52.5 years [43, 60], p&lt;0.001), had a higher body mass index (BMI) (median 26.7 kg/m2 [23.4, 29.0] vs. 24.3 kg/m2 [20.7, 27.4], p=0.013), had more comorbidities and were more likely targeted for destination therapy (DT) (36.1% vs. 14.3%, p=0.010). Death occurred in 33.3% of HM3 patients, compared to 22.9% of HW patients, p=0.247 (probability of survival at 2 years 54.7% vs. 74.1%, p=0.296). After adjustment for confounders, we observed a significant 6-fold risk increase in device malfunctions for HW (hazard ratio (HR) 6.49, 95% CI [1.89, 22.32], p=0.003), but no significant differences between devices in pump thrombosis (p=0.173) or overall survival (p=0.801).

Conclusions
Comparing long-term outcomes between HeartMate 3 and HeartWare HVAD for LVAD support from a prospective registry, HeartWare HVAD patients had a significantly higher risk of device malfunctions. No significant differences were evident between devices in overall survival, and in respect to most clinical outcomes.

Funding Acknowledgement
Type of funding sources: None. KM Plot primary and secondary outcomesRisk analysis on all outcomes
Using group concept mapping software to develop a conceptual framework of left ventricular assist device recipients' experiences
Authors: Slade A.L , O'Hara M.E , Quinn D , Marley L , Griffith S , Haque M.S , Calvert M.J , Lim S , Lane D.A 
Published: October 2021

Abstract

Background
Advanced Heart failure (AHF) carries a high mortality rate. Heart transplantation is one therapeutic option, but low donation rates limits its availability. A left ventricular assist device (LVAD) is an alternative therapy which helps relieve symptoms, while improving prognosis and quality of life. However, lack of donors also means that the LVAD becomes a destination therapy by default.(1) Living with an LVAD requires significant psychological, social and physical adaptation for the recipients' and their families.(2) Patient reported outcome measures (PROMs) are one way of capturing these concerns and ongoing problems. Discussions with a patient and public involvement group found a range of issues not currently captured by available PROMS.

Aim
To develop a conceptual framework which reflects the experiences of LVAD recipients' and evaluate their importance for inclusion in PROMs using a research web platform.

Method
Participants were recruited from a regional transplant centre which covers a wide geographical area in the UK. Ethical approval was obtained and participants were recruited through routine LVAD clinics. Group concept mapping (GCM) is a semi-quantitative mixed methods approach that can be used to capture and quantify recipients' experiences.(3) Groupwisdom concept mapping software was used as the electronic data collection platform.(4) GCM consists of 3 stages: statement generation, thematic statement sorting, and rating statements for importance, relevance and frequency of impact. Multidimensional scaling and hierarchical cluster analysis produces visual representations of recipients' experiences as a points and cluster map, and scoring of statements produces relative importance of items across the clusters.

Results
18 LVAD recipients consented to take part. 101 items and 9 clusters were generated. Clusters represented: Activities; Partner/family dependency; Travel; Mental well-being; LVAD challenges; Equipment and clothing; Physical and cognitive limitations; Restrictions, and LVAD positives. LVAD Positives and LVAD restrictions were rated high for frequency, relevance and importance. Physical and cognitive limitations was rated high for importance and frequency. Equipment was rated high for relevance and frequency, and Challenges was rated high for relevance.

Conclusion
GCM and the online software is a useful tool for developing a conceptual framework and mapping key areas of importance for LVAD recipients, especially, when prioritising important patient reported outcome domains for use in clinical practice, future research and design evolution. Using an electronic platform allowed us to reach participants dispersed over a wide geographical area.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): British Heart FoundationNational Institute for Health Research Cluster Rating Map for Importance
Prospective evaluation of donor-derived cell-free DNA as a potential biomarker for cardiac allograft vasculopathy
Authors: Jimenez-Blanco Bravo M , Perez Gomez L , Arellano Serrano C , Hernandez Perez F.J , Gomez Bueno M , Torres Sanabria M , Segovia Cubero J 
Published: October 2021

Abstract

Background
Cardiac allograft vasculopathy (CAV) remains a major cause of morbidity and mortality among long-term heart transplant (HT) recipients. There is clearly an unmet need for a noninvasive biomarker of CAV that could obviate the need to perform surveillance coronary angiograms in these patients.

Purpose
Our aim was to evaluate the performance of Donor-derived Cell Free DNA (dd-cfDNA) as a biomarker of CAV.

Methods
We prospectively measured dd-cfDNA levels in all consecutive asymptomatic patients undergoing surveillance coronary angiography &gt;1 year after HT at a single center, between Jan 2019 and Jan 2021. Endpoints included the association between dd-cfDNA levels and the presence CAV, according to ISHLT 2010 classification. Patients with history of acute cellular rejection ≥1R or antibody mediated rejection in the previous 6 months were excluded.

Results
We included 94 HT recipients, median age 57 years (IQR 50–67), 67% men, a median of 10.9 years after transplant. Coronary angiogram revealed CAV0, CAV1, CAV2 and CAV3 in 61%, 19%, 14% and 6% of patients, respectively. Median dd-cfDNA values for each CAV group were: CAV0 0.92% (IQR 0.46–2.0), CAV1 1.4% (0.38–2.8), CAV2 0.17% (0.07–0.52) and CAV3 0.24% (0.057–0.87); p=0.0535. Figure 1 summarizes baseline characteristics of the cohort and results.
Comparison of dd-cfDNA levels in patients with CAV0 and CAV1–2-3 did not show significant differences (0.92%, IQR 0.46–2.0 vs 0.46%, IQR 0.075–1.5, p=0.059) (Figure 2A), nor did the comparison between patients with stable CAV (no new coronary lesions since previous angiogram, n=77) and progressive CAV (patients with new coronary stenoses, n=17); median dd-cfDNA values were 0.735% (IQR 0.195–2.0) vs 0.9% (IQR 0.12–1.8), p=0.76 (Figure 2B). A subanalysis according to time after HT was also found non-significant: less than 5 years (p=0.95), 5 to 10 years (p=0.14) and more than 10 years after HT (p=0.16) (Figure 2C). The AUC ROC curve for the diagnosis of CAV revealed the lack of ability to predict the presence of any degree of CAV (AUC ROC = 0.38).

Conclusion
In our experience, dd-cfDNA did not perform as a useful biomarker to avoid surveillance coronary angiograms for CAV diagnosis.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Sociedad Madrileña de Trasplantes