bluuebunny/crossref_metadata_2025_split huggingface dataset:
Characteristics and prognosis in heart failure with preserved ejection fraction patients without left ventricular hypertrophy
Authors: Nakagawa Y , Tamaki S , Yano M , Hayashi T , Yamada T , Yasumura Y , Hikoso S , Sotomi Y , Sakata Y ,   the OCVC-Heart Failure investigator
Published: October 2021

Abstract

Background
Clinical heterogeneity exists in heart failure with preserved ejection fraction (HFpEF). Left ventricular (LV) structure in HFPEF is characterized by normal LV cavity size and LV hypertrophy (LVH). However some of HFPEF patients do not have LV hypertrophy, and these patients may have distinct characteristics,

Purpose
The purpose of this study is to clarify the clinical characteristics and the prognosis for HFPEF patients without LVH.

Methods
We studied 1097 patients, who were hospitalized for acute decompensated heart failure with LVEF ≥50%, and enrolled in the PURSUIT-HFpEF registry. Laboratory testing and echocardiography were examined in the compensated stage (in stable condition after treatment of acute decompensated HF). We divided these patients into 2 groups based on LV mass index (LVMI) in the compensated stage according to the American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations; patients with LVH (48%) and those without LVH (52%).

Results
Patients without LVH had significantly lower levels of C-reactive protein and N-terminal pro brain natriuretic peptide (NT-proBNP) and higher levels of estimated glomerular filtration rate in the compensated stage than those with it (p&lt;0.05 for all). Cox hazard regression analysis showed that absence of LVH was favorably associated with the primary composite endpoint of all-cause death, HF rehospitalization, and cerebrovascular events (hazard ratio 0.776, 95% confidence interval 0.620-to 0.970, p&lt;0.05).
On the other hand, the frequency of atrial fibrillation (Af) in the decompensated stage was higher in patients without LVH than those with it (52.1% vs 39.3%, p&lt;0.001). Multivariate logistic analysis showed that absence of LVH was independently associated with presence of Af in the decompensated stage (odds ratio=1.520, 95% confidence interval 1.130 to 2.050, P&lt;0.01)

Conclusions
HFPEF patients without LVH have less organ damage and favorable prognosis. Af may play a role in the decompensation of HF in HFPEF patients without LVH.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Roche Diagnostics K.K. (Grant number: not applicable)Fuji Film Toyama Chemical Co., Ltd. (Grant number: not applicable)
Prognostic value of relative wall thickness in heart failure with preserved ejection fraction: what is the best method for its calculation?
Authors: Pires M , Santos J.M , Correia J , Neto V , Ferreira G , Costa Cabral J , Almeida I 
Published: October 2021

Abstract

Background
The HFA-PEFF diagnostic algorithm is a recently published tool to help in the diagnosis of heart failure with preserved ejection fraction (HFpEF). One of the echocardiographic diagnostic criteria is left ventricular (LV) relative wall thickness (RWT), an index of LV concentricity. LV wall thickness can be measured by echocardiography at the posterior wall (PW) and/or the interventricular septum (IVS) in parasternal long axis view. There are three methods of RWT calculation: RWTPW= 2xPW/LV dimension at end diastole (LVDd) – the most used method, RWTIVS = 2 x IVS / LVDd and RWTPW + IVS = (PW + IVS) / LVDd. This study compares the prognostic value of these 3 methods of calculation in patients with acute HFpEF.

Methods
All patients admitted with acute HFpEF in a Cardiology Department during 7 years were included. RWT was considered elevated if superior to its median and was calculated with the 3 formulas. In-hospital mortality (IHM) was evaluated. The primary endpoint (EP) was a composite of all-cause mortality or hospitalization for HF during follow-up of 24 months. Statistical analysis used chi-square and Mann-Whitney U tests, binary logistic regressions, and Kaplan-Meier curves.

Results
478 patients were studied (61.3% female, mean age 79.4±8.3 years). Mean RWTPW, RWTIVS and RWTPW+IVS were 0.46±0.16, 0.50±0.17 and 0.48±0.16, respectively. IHM was 3.4% and primary EP occurred in 57.8%.
High RWTPW was associated with higher LV ejection fraction (LVEF) (p&lt;0.001). Patients with high RWTIVS were older (p=0.044). High RWTPW+IVS was associated with higher left atrial area (p=0.037) and higher LVEF (p=0.002).
There was no statistically significant difference between patients with high and low RWT, calculated using the 3 formulas, in other indices that are commonly used to assess diastolic function, namely in e' and E/e'.
None of the 3 methods of RWT calculation was a predictor of IHM.
Survival analysis showed that patients with high RWTPW had higher incidence of the primary EP (43.2% vs. 16.8%, Kaplan-Meier χ2=5.99; p=0.014), but not patients with high RWTIVS (Kaplan-Meier χ2=0.23; p=0.631) or RWTPW+IVS (Kaplan-Meier χ2=1.92; p=0.166).
RWTPW was a predictor of primary EP (OR 1.81; 95% CI 1.15–2.85; p=0.011) and this result was independent from e' and E/e' (OR 2.96; 95% CI 1.08–8.10; p=0.035).

Conclusion
In this study comparing 3 formulas for calculation of RWT, RWTPW had better risk prediction during follow-up than RWTIVS or RWTPW+IVS. RWTPW was a predictor of all-cause mortality and hospitalization for HF, and was independent from e' and E/e', indexes that are also recommended in HFA-PEFF diagnostic algorithm. Therefore, the formula incorporating PW should be preferred in the evaluation of patients with suspected or diagnosed HFpEF.

Funding Acknowledgement
Type of funding sources: None.
Features of changes in the level of fibrosis markers in lipotoxic myocardial damage in patients with epicardial obesity
Authors: Gritsenko O , Chumakova G 
Published: October 2021

Abstract

In visceral obesity, lipotoxic myocardial damage develops, which leads to the formation of myocardial fibrosis with impaired diastolic function and the development of heart failure (HF). Currently, the search for markers of early diagnosis of left ventricular (LV) diastolic dysfunction (DD) is relevant.

Objective
To study the features of changes in the level of fibrosis markers in lipotoxic myocardial damage in patients with epicardial obesity (EO).

Materials and methods
The study included 125 men with general obesity (BMI average 33.24±3.65 kg / sq. m.). All patients underwent transthoracic echocardiography (ECG) to assess the thickness of epicardial adipose tissue (tEAT) as the equivalent of visceral obesity, as well as to diagnose DD LV. According to the results of echocardiography, the patients were divided into 2 groups: EO(+) with epicardial fat thickness (tEAT) ≥7 mm (n=78); EO(−) with tEAT &lt;7 mm (n=40). DD LV was detected in 7 patients, who were subsequently excluded from the analysis. All patients were assessed for profibrotic markers in the blood serum (MMP-3, collagen I, collagen III, TGF – β, VEGFA, PICP) using enzyme immunoassay. The level of free fatty acids (FFA), as early markers of lipotoxic myocardial damage, was also determined in all patients using enzymelinked immunosorbent assay. The peak untwist ratio LV was studied using speckle-tracking ECG. The exclusive criteria were the presence of coronary pathology, arterial hypertension, type 2 diabetes mellitus, as possible causes of lipotoxic myocardial damage.

Results
When studying the features of changes in the level of serum markers of myocardial fibrosis, a statistically significant increase in the level of all the studied markers was revealed in the EO(+) group compared to the EO(−) group, and a statistically significant increase in the level of FFA in the EO(+) group compared to the EO(−) group (0.84±0.02 mmol/l and 0.35±0.01 mmol/L, respectively, p=0.02). A statistically significant relationship was found between the levels of FFA and collagen III (r=0.32, p=0.03) and TGF – β (r=0.30, p=0.04). According to the results of speckle-tracking ECG in the EO(+) group, an increase in the rate of LV untwist to −125.56 (−141.0; −117.0) deg/s (p=0.003) was determined. When studying the effect of FFA as a marker of lipotoxic effect on the myocardium, a weak statistically significant relationship was revealed between the level of FFA and the rate of LV untwist (r=0.27; p=0.03) in the EO(+) group, while no such effect was found in the EO(−) group.

Conclusion
In EO, as a result of neurohumoral disorders, lipotoxic myocardial damage develops and progresses, leading to LV DD, the detection of which is probably possible with the help of the LV unwinding rate.

Funding Acknowledgement
Type of funding sources: None.
Serum uric acid is associated with the progression of left ventricular diastolic dysfunction in apparently healthy subjects
Authors: Yang C.D , Wang X.Q 
Published: October 2021

Abstract

Background
Left ventricular (LV) diastolic dysfunction (LVDD) which is one of major characteristics of diastolic heart failure (HF) is also prevalent in the community. Patients with LVDD are predisposed to poor cardiovascular outcomes. Serum uric acid (SUA), an important component of metabolic disorders, has been shown to have close relationship with cardiovascular events including LVDD. In the present study, we sought to investigate whether SUA is a potential predictor of LVDD progression in relatively healthy subjects.

Methods
From November 2018 to December 2019 in our Hospital, subjects who had physical examination were consecutively enrolled and followed up for ∼12 months. LVDD was graded by tissue doppler imaging (TDI). At baseline, only individuals with normal LV diastolic function or mild LVDD were finally enrolled and underwent repeated echocardiography and TDI assessment after follow-up. The incidence of LVDD progression, defined as LVDD grade 0–1 escalated to grade 2–3, and its relationship with SUA levels were analyzed. Multivariate regression models were constructed to test the predictive value of SUA for LVDD progression.

Results
A total of 1082 subjects were included in the final analysis. During a mean follow-up of 12.6 (IQR 12.0–13.8) months, the incidence of LVDD progression was 37.6% and mean change in E/e' ratio was 1.18±1.85 cm/s, which was positively correlated with baseline SUV level (Spearman's r=0.140, P&lt;0.001). In multivariate analysis, SUA was independently associated with LVDD progression after adjustment for traditional risk factors. The highest quartile of SUA corresponded to a 1.851-fold [95% CI 1.215–2.828] increased risk for progression of LVDD as compared to the lowest quartile. A 100 μmol/L increase in SUA conferred a 1.351-fold [95% CI 1.125–1.625] higher risk of LVDD progression when treated as continuous variable. Principal component analysis revealed SUA accounted for 14.7% of the variance in patients with LVDD progression, following insulin resistance and cholesterol factor which accounted for 27.9% and 19.0%, respectively.

Conclusions
This study suggests that SUA is an independent predictor of LVDD progression in apparently healthy subjects.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Natural Science Foundation of China, Shanghai Municipal Commission of Health and Family Planning
Updated results of hybrid transcatheter and minimally invasive left ventricular reconstruction for the treatment of ischemic cardiomyopathy
Authors: Klein P , Van Kuijk J.P , Swaans M.J 
Published: October 2021

Abstract

Aims
Remodelling of the left ventricle (LV) after anterior myocardial infarction can result in a pathological increase in LV volume and reduction in LV ejection fraction (EF). We describe the updated results of an l hybrid transcatheter and minimally invasive surgical technique to reconstruct the negatively remodelled LV by myocardial scar plication and exclusion to rehape and reduce the excess volume, decrease the wall stress and increase LVEF.

Methods and results
Patients were considered eligible for the procedure when they presented with symptomatic heart failure (NYHA-class ≥II or more) and ischemic cardiomyopathy (EF&lt;40%) after anterior myocardial infarction. All patients had a dilated LV with either a- or dyskinetic scar in the anteroseptal wall and/or apex of ≥50% transmurality. Hybrid transcatheter and minimally technique that relies on micro-anchoring technology is used to reconstruct the LV by plication of the fibrous scar. A series of internal and external micro anchors are brought together over a PEEK (poly-ether-ether-ketone) tether to form a longitudinal line of apposition between the LV free wall and the anterior septum from the mid-ventricle to the apex. Internal anchors are deployed by transcatheter technique on the right side of the ventricular septum through the right internal jugular vein. Paired external anchors are advanced through a left sided mini-thoracotomy and deployed on the LV epicardium (figure 1). A specialized Force Gauge is used to bring these “RV-LV” anchors together under measured compression forces. “LV-LV” anchor pairs through the LV apex beyond the distal tip of the RV complete the reconstruction.
Between October 2016 and March 2021 28 patients (23 males, 5 females; mean age 61±12 years) were operated in a single Dutch centre. Procedural success was 100%. On average 2.3±0.8 anchor-pairs were used to reconstruct the LV. Comparing echocardiographic data pre- and directly postoperatively, LVEF increased from 33±8% to 44±10% (change +35%, P&lt;0.0001) and LV-volumes decreased: LVESV 116 ml ± 52 ml to 69±39 ml (change −35%, P&lt;0.0001) and LVEDV 170 ml ± 72 ml to 118±55 ml (change −29%, P&lt;0.0001). Hospital mortality was 0%. Also no strokes occurred. Median duration of ICU–stay was 2 days (IQR 1–48 days) and median length of hospital stay was 7 days (IQR 5–61 days). Survival at 48 months was 84%. At latest follow-up, 9670% of surviving patients were in NYHA-class I-II compared to 18% preoperatively.

Conclusions
Hybrid transcatheter and minimally invasive LV reconstruction is a promising novel treatment option for patients with symptomatic heart failure and ischemic cardiomyopathy after anteroseptal myocardial infarction. Updated results demonstrate that the procedure is safe and results in significant improvement in EF, reduction in LV volumes and sustained improvement in heart failure symptoms.

Funding Acknowledgement
Type of funding sources: None. Figure 1
The odyssey to dethrone LV ejection fraction continues: the prognostic value of LV global function index in heart failure
Authors: Rocha B , Cunha G , Sousa J.A , Maltes S , Freitas P , Brizido C , Strong C , Ribeiras R , Andrade M.J , Aguiar C , Ferreira A , Mendes M 
Published: October 2021

Abstract

Background
Left Ventricular (LV) Global Function index (LVGFi) is a parameter that combines data from global systolic performance and volumetric anatomical information, measurable by non-contrast Cardiac Magnetic Resonance (CMR). We aimed to evaluate whether LVGFi predicts major cardiovascular outcomes and outperforms LV ejection fraction (LVEF) in Heart Failure (HF).

Methods
We conducted a retrospective single-centre study of consecutive patients with HF who were referred to and had a LVEF &lt;50% at CMR. Other than inadequate images for endocardial or epicardial border delineation, there were no exclusion criteria. LVEF was determined by 3D measurement. LVGFi was calculated as the LV stroke volume to the LV global volume ratio (Figure 1). The primary endpoint was a composite of time to all-cause death or HF hospitalization.

Results
The cohort was comprised of 433 HF patients (mean age 64±12 years, 74.1% male, ischaemic HF 53.1%, NYHA I-II 83.9%) with a mean LVEF of 33.5±10.0% and LVGFi of 22.8±7.4%. Over a median follow-up of 27 (17–37) months, 85 (19.6%) met the primary endpoint and 42 (9.7%) died. Patients with an event of the primary endpoint had markers of more severe HF, as noted by a reduced functional capacity (NYHA I-II: 63.5 vs. 89.0%; p&lt;0.001) and increased natriuretic peptides [NT-proBNP: 2664 (1022–27242) vs. 791 (337–7258); p&lt;0.001). Likewise, CMR showed higher LV volumes (e.g., LV end-diastolic volume index: 137±50 vs. 120±43mL/m2; p=0.001) and reduced LV performance indices, namely LVEF (29.2±10.6 vs 34.5±9.6%; p&lt;0.001) and LVGFi (19.8±7.4 vs 23.6±7.3%; p&lt;0.001). Both LVEF and LVGFi independently predicted the primary endpoint in multivariate analysis (separately imputed into a model adjusted for NYHA, NT-proBNP and creatinine). The LVEF model was more powerful than that of LVGFi. Similarly, LVGFi did not provide incremental prognostic information over LVEF in c-statistics analysis (0.653 vs. 0.622; p=0.645) (Figure 2).

Conclusion
While LVGFi independently predicted major outcomes in patients with HF and LVEF &lt;50%, it did not surpass LVEF. Our findings contrast to those demonstrating LVGFi as a powerful variable that outperforms LVEF in hypertrophic cardiomyopathy, cardiac amyloidosis, and healthy subjects at risk of developing structural heart disease. We hypothesize that LVGFi might be primarily useful in the prognostic stratification of patients with preserved LVEF.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Kidney function derangements during summer in ambulatory heart failure patients
Authors: Spitaleri G , Cediel G , Santiago-Vacas E , Codina P , Domingo M , Zamora E , Santesmases J , Diez-Quevedo C , Troya M , Boldo M , Alonso N , Gonzalez B , Nunez J , Lupon J , Bayes-Genis A 
Published: October 2021

Abstract

Background
Heart failure (HF) is characterized by alterations in kidney function that are associated with poor prognosis and can be related to the evolution of the disease or induced by medical treatment. High temperatures during summer may result in some degree of dehydration, especially in patients treated with diuretics, and may contribute to transient glomerular filtration rate (eGFR) reduction.

Objective
To assess creatinine and eGFR changes during summer in ambulatory heart failure patients.

Methods
Consecutive patients with HF admitted at our HF Clinic (Spain) from August 2001 to December 2020 were included. eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula. We included in the analysis creatinine and eGFR values that were assessed at planned visits only, discarding urgent renal function assessments. Creatinine and eGFR values were grouped according to the period of the year (summer [from June to September, both included] vs. the rest of the year). Changes in creatinine and eGFR between the rest of the year and summer for each patient were evaluated using paired samples t-test.

Results
Out of 37360 creatinine and eGFR values, 25458 were included in the analysis for a total of 2423 patients (median number of observations for each patient: 8, IQR 4–15). Mean creatinine and eGFR were 1.4±1.0 mg/dl and 63.0±27.7 ml/min, respectively. Table 1 shows baseline patient characteristics. Creatinine increased significantly during summer (1.44±0.9 mg/dl vs. 1.48±1.1 mg/dl, p&lt;0.001). Similarly, eGFR was lower in summer as compared to the rest of the year 60.6±25.4 ml/min vs. 59.4±26.0 ml/min, p&lt;0.001.

Conclusions
In ambulatory HF patients in a Mediterranean area, we found significant worsening of renal function during summer, likely related to an imbalance between water intake and fluid loss. To prevent summer-driven kidney stress, diuretic treatment should be carefully adjusted during the hottest months of the year.

Funding Acknowledgement
Type of funding sources: None. Table 1
Prognostic significance of N-Terminal Pro-BNP in patients with COVID-19 pneumonia without previous history of heart failure
Authors: Selcuk M , Keskin M , Cinar T , Gunay N , Dogan S , Cicek V , Kilic S , Asal S , Yavuz S , Keser N , Orhan A.L 
Published: October 2021

Abstract

Introduction
The objective of the present research was to evaluate the possible association between the N-terminal pro-brain type natriuretic peptide (NT-proBNP) levels and in-hospital mortality in coronavirus disease 2019 (COVID-19) pneumonia patients who did not have pre-existing heart failure (HF).

Methods
A total of 137 consecutive patients without pre-existing HF and hospitalized due to COVID-19 pneumonia were enrolled into the current research. The main outcome of the research was the in-hospital death. The independent parameters linked with the in-hospital death were determined by multivariable analysis.

Results
A total of 26 deaths with an in-hospital mortality rate of 18.9% was noted. Those who died were older with an increased frequency of co-morbidities such as hypertension, chronic kidney disease, coronary artery disease, stroke and dementia. They had also increased white blood cell (WBC) counts and had elevated glucose, creatinine, troponin I, and NT-pro-BNP levels but had decreased levels of hemoglobin. By multivariable analysis; age, NT-pro-BNP, WBC, troponin I, and creatinine levels were independently linked with the in-hospital mortality. After ROC evaluation, the ideal value of the NT-pro-BNP to predict the in-hospital mortality was found as 260 ng/L reflecting a sensitivity of 82% and a specificity of 93% (AUC:0.86; 95% CI: 0.76–0.97).

Conclusion
The current research clearly shows that the NT-proBNP levels are independently linked with the in-hospital mortality rates in subjects with COVID-19 pneumonia and without HF. Thus, we believe that this biomarker can be used as a valuable prognostic parameter in such cases.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Natriuretic peptide referral thresholds and heart failure diagnosis: population-based cohort study
Authors: Taylor C , Ordonez-Mena J.M , Lay-Flurrie S , Goyder C , Jones N , Roalfe A , Hobbs F.D.R 
Published: October 2021

Abstract

Background
Natriuretic peptide (NP) testing is recommended by both the European Society of Cardiology (ESC) and the National Institute for Health and Care Excellence (NICE) for people presenting with symptoms of heart failure (HF) in primary care. However, ESC and NICE guidelines suggest different NP referral thresholds: ESC recommend referral at a lower NP level (BNP≥35pg/ml / NT-proBNP≥125pg/ml) compared to NICE (BNP≥100pg/ml/NT-proBNP≥400pg/ml).

Purpose
We aimed to evaluate NP test performance for HF diagnosis for ESC and NICE guideline-defined thresholds.

Methods
Population-based cohort study using linked primary and secondary care data from the Clinical Practice Research Datalink in England between 1st January 2000 and 31st December 2018. Participants were adults aged 45 years and above with a NP result: 74,233 had a BNP and 155,347 had a NT-proBNP measurement. The main outcome measures were diagnostic performance of NP test (sensitivity, specificity, positive predictive value, negative predictive value) by threshold.

Results
A total of 229,580 patients had a NP test and 21,102 (9.2%) were diagnosed with HF. The ESC NT-proBNP threshold of 125pg/ml had a sensitivity of 94.6% (94.2 to 95.0) and specificity of 50.0% (49.7 to 50.3) compared to sensitivity of 81.7% (81.0 to 82.3) and specificity of 80.3% (80.0 to 80.5) for the NICE NT-proBNP 400pg/ml threshold. For both guidelines, nearly all patients with a NP level below the threshold did not have HF (negative predictive value ESC 98.9% (98.8 to 99.0) and NICE 97.7% (97.6 to 97.8). Similar performance was found for BNP.

Conclusions
The performance of NP testing is dependent on the guideline-specified threshold for referral. In 100 people with HF, using the NICE threshold would falsely reassure 18 patients, whereas the lower ESC threshold would miss just 5 people but twice as many patients would be referred for diagnostic assessment. The optimal NP threshold for referral for HF diagnosis will depend on the healthcare setting. The trade-off between missing HF cases and overwhelming diagnostic services needs to be determined at a national level.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institute for Health Research