bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of induction therapy on outcomes after heart transplantation
Authors: Briasoulis A , Doulamis I , Kampaktsis P , Alvarez P 
Published: October 2021

Abstract

Introduction
Approximately 50% of heart transplant (HT) programs currently employ a strategy of induction therapy (IT) with either interleukin-2 receptor antagonists (IL2RA) or polyclonal anti-thymocyte antibodies (ATG) during the early postoperative period. However, the overall utility of such therapy is uncertain and data comparing induction protocols are limited.

Methods
Adult HT recipients were identified in the United Network for Organ Sharing (UNOS) registry between 1990 and 2020. Patients were grouped according to administration of induction in the post-operative period after HT. Accounting for re-transplantation, Fine and Gray's test compared cumulative incidences of all-cause mortality between groups. Univariate and multivariate analysis were performed using the competing risk model. The risk of treated rejection and hospitalization for infection or rejection was analyzed with multivariable logistic regression.

Results
A total of 63,849 HT recipients were included in the study and among those 59% did not receive induction, 16.6% received ATG, 19.1% IL2RA, 0.7% alemtuzumab, and 4.6% OKT3. Since 2000 IL2RA is the most frequently used form of induction therapy whereas OK3 is not used in the past decade. In multivariable logistic regression models, use of ATG is associated with lower risk of treated rejection at one year after HT (relative risk ratio 0.55, 95% CI 0.47–0.63, p&lt;0.001) compared with no induction whereas IL2RA had similar risk of treated rejection. Similarly, the risk of rejection requiring hospitalization was significantly lower with ATG than no induction. No significant differences in rates of infection requiring hospitalization were noted between groups. Moreover, no differences in rates of post-transplant lymphoproliferative disease and any malignancy were noted between those receiving induction versus no induction. Adjusted all-cause mortality was significantly lower among those treated with ATG than patients that did not receive induction therapy (sub-hazard ratio 0.72, 95% CI 0.63–0.82, p&lt;0.001) (Figure).

Conclusion
Induction therapy with IL2RA is the most used approach. ATG is associated with lower risk of treated rejection and all-cause mortality than no induction and IL2RA.

Funding Acknowledgement
Type of funding sources: None.
Prognostic significance of non-sustained ventricular tachycardia on stored electrograms of heart failure patients with cardiovascular implantable electronic devices
Authors: Barradas Da Silva M , Duarte F , Oliveira L , Serena C , Fontes A , Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D 
Published: October 2021

Abstract

Background
Non-sustained ventricular tachycardia (NSVT) is commonly found in patients with structural heart disease and was historically obtained from registers of external ambulatory monitoring. The advent of Cardiac implantable electronic devices (CIEDs) has made it possible to detect asymptomatic NSVT in Heart Failure (HF) patients more frequently, but its true impact in real world is uncertain, and often does not lead to a change in clinical intervention.

Purpose
To determine the prognostic significance of NSVT detection on stored electrograms of CIEDs in HF patients with systolic left ventricle dysfunction.

Methods
We retrospectively enrolled 132 consecutive HF patients (mean age 67,5±11,1 years, males 72,0%) with systolic left ventricle dysfunction and CIEDs (biventricular pacemakers with or without cardiac defibrillators). Patients were evaluated through CIEDs interrogation and clinical evaluations and divided into NSVT positive (Group 1) and negative groups (Group 2). Mean follow-up period was 62,8±7,1 months.

Results
NSVT was detected in 51 (38,6%) patients. 70 (53,0%) had implantable cardiac resynchronization therapy (CRT) defibrillator (CRT-D), 37 (28,0%) transvenous implantable cardioverter defibrillator (ICD), 13 (9,8%) CRT pacemaker (CRT-P) and 12 (9,1%) subcutaneous ICD (S-ICD). Medium left ventricular ejection fraction (LVEF) was 31,1±7,9%, 20,6% were in NYHA III-IV and 47,0% were ischemic (49% Group 1 and 45,7% Group 2, p=0,708). Dyslipidemia was more prevalent in Group 2 (p=0,042). In total 11 (8,3%) patients died, 2 (1,5%) from sudden cardiac death and 5 (3,8%) from cardiovascular death. NSVT was associated with CIEDs treatments (hazard ratio [HR]2,52; 95% confidence interval [CI]1,2–5,1; p=0,001), ventricular fibrillation (VF) (HR: 3,71, 95% CI: 1,19–11,58; p=0,018), sustained ventricular tachycardia (VT) (HR: 9,06, 95% CI: 2,82–29,12; p&lt;0,05) and composite outcome of VT, VF, HF re-admissions and related admissions to emergency department (ED) and death by all causes (HR: 2,52; 95% CI: 1,20–5,10; p=0,011). NSVT at 1 year was associated with HF readmissions at 1 year (p=0,004).

Conclusions
On extended monitoring possible with CIEDs, NSVT in HF patients was associated with a worse prognosis and may serve as a predictor of significant arrhythmic events, HF hospitalizations and mortality. These findings enhances the importance of remote monitoring and optimization of therapeutic modalities in these patients along with a close supervision.

Funding Acknowledgement
Type of funding sources: None.
Sex-related differences in cardiovascular risk factor accumulation and incident heart failure: data from the PREVEND observational cohort
Authors: Dronkers J , Meems L.M.G , Van Veldhuisen D.J , Meyer S , Kieneker L.M , Gansevoort R.T , Bakker S.J.L , Rienstra M , De Boer R.A , Suthahar N ,   University Medical Centre Groningen, Department of Cardiology, AB 31 Hanzeplein 1, 9713GZ, Groningen, the Netherlands
Published: October 2021

Abstract

Purpose
To examine whether cardiovascular risk factor development over time would associate differently with incident heart failure (HF) in women and men.

Methods
In the PREVEND (Prevention of Renal and Vascular End-stage Disease) cohort, we calculated the incidence rates (IR) of HF and cardiovascular risk factors using Poisson regression. We examined sex-related differences in relative rates of HF according to cardiovascular risk factor development using IR-ratio (IRR=IRrisk-factor/IRno-risk-factor) and Cox regression models.

Results
Among 8592 participants (mean age 49.8 years; 50.1% women), 241 men and 133 women developed HF over 12.5 (12.2–12.9) years, resulting in an overall HF incidence rate of 5.12 (per 1000 person-years) in men versus 2.69 in women. Men also had higher incidence rates of diabetes (IRmen: 7.23 vs IRwomen: 4.46), hypertension (IRmen: 27.93 vs IRwomen: 21.35) and myocardial infarction (IRmen: 3.73 vs IRwomen: 1.33). Relative rates of HF in individuals developing obesity, diabetes and MI were comparable in both sexes (P&gt;0.05), but development of hypertension more strongly associated with incident HF in women (IRRwomen: 6.49; 95% CI: 3.04–13.87 vs IRRmen: 2.34; 95% CI: 1.38–3.95, P=0.030). Similar trends were observed in an adjusted Cox-regression model (women:men HR: 2.93; 95% CI: 1.15–7.45; p=0.024).

Conclusions
Cardiovascular risk factors develop more often in men and associate with higher absolute rates of HF in men. However, in individuals developing hypertension, the relative rate of HF is higher in women compared to men. Our results suggest that aggressive and sex-specific risk factor management may be helpful to prevent incident HF.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Netherlands Heart Foundation;Public EU grant - European Research Council
Additive prognostic value of cardiac biomarkers in patients with chronic obstructive pulmonary disease and heart failure
Authors: Aimo A , Vergaro G , Januzzi J , Richards A.M , Lam C.S.P , Latini R , Bayes-Genis A , Brunner-La Rocca H.P , De Boer R , Ueland T , Gaggin H.K , Anand I , Troughton R , Passino C , Emdin M 
Published: October 2021

Abstract

Background
Chronic obstructive pulmonary disease (COPD) is a frequent comorbidity in patients with heart failure (HF). We assessed the influence of COPD on circulating levels and prognostic value of 3 HF biomarkers: N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity troponin T (hs-TnT), and soluble suppression of tumorigenesis-2 (sST2).

Methods
Individual data from patients with chronic HF, known COPD status and NT-proBNP, hs-TnT, sST2 values (n=13328) were analysed.

Results
As compared to patients without COPD, those with COPD (n=2155, 16%) were older (age 71 years [64–77] vs. 66 [57–75]; p&lt;0.001), more frequently men (79% vs. 74%; p&lt;0.001), had more severe dyspnoea (43% in New York Heart Association [NYHA] class III-IV vs. 31%; p&lt;0.001), slightly worse renal function (median estimated glomerular filtration rate [eGFR] 58 mL/min/1.73 m2 [43–73] vs. 60 [46–77]; p&lt;0.001), higher NT-proBNP (1508 ng/L [650–3363] vs. 1239 ng/L [479–2911]; p&lt;0.001), hs-TnT (22 ng/L [13–38] vs. 17 ng/L [9–30]; p&lt;0.001), and sST2 (31 ng/mL [23–45] vs. 29 [21–43]; p=0.040). In both the COPD and no-COPD subgroups, the best cut-offs of the 3 biomarkers refined the prediction of 1- and 5-year all-cause and cardiovascular mortality and 1- to 12-month HF hospitalization over a prognostic model including age, sex, ischemic aetiology, eGFR, HF categories, NYHA III-IV, beta-blocker use and the NT-proBNP cut-off alone.

Conclusions
Among patients with HF, those with COPD have higher circulating cardiac biomarkers. Patient classification based on COPD-specific cut-offs refines risk reclassification for all-cause and cardiovascular mortality and HF hospitalization and might be helpful for decision making and management.

Funding Acknowledgement
Type of funding sources: None.
Predictability of cardiotoxicity at a Belgian cardio-oncology clinic without mandatory physician referral
Authors: Jacobs J , Guler I , Janssens S , Van Aelst L.N.L 
Published: October 2021

Abstract

Background and purpose
Increased morbidity and mortality caused by side-effects of cancer treatment on cardiovascular function mandates careful monitoring and shared decision-making in cardio-oncology clinics. We report the experience of the cardio-oncology clinic at a large Belgian tertiary care center, without mandatory physician referral, and investigated the predictability of cardiotoxicity based on pre-existing cardiovascular risk factors, specific cancer treatment and existing risk scores of the American Society of Clinical Oncology (ASCO) and Mayo Clinic.

Methods
We included all patients seen at the outpatient cardio-oncology clinic between May 2018 and September 2020. We defined cardiotoxicity as a decline in ejection fraction (EF) of 10% in asymptomatic patients and 5% in symptomatic patients. Approval of the ethical committee was obtained (S65084).

Results
The majority were women (68%), with almost half (44%) having metastatic disease. Mean age was 63.4±16.0 years. The most frequent oncological diagnoses were breast cancer (33%) and haematological diseases (24%). Patients most frequently received radiation therapy (42%), anthracyclines (39%) and antimetabolites (35%). Mean follow-up was 443±245 days.
Receiver operating characteristic (ROC) analysis of predictors of cardiotoxicity showed an area under the curve (AUC) of 0.580 (CI 95% bootstrap: 0.525–0.642) for cardiovascular risk factors alone, and an AUC of 0.613 (CI 95% bootstrap: 0.550–0.676) when treatment was added to the model. The ASCO risk score poorly predicted cardiotoxicity (sensitivity 64%, specificity 52%). The Mayo Clinic cardiotoxicity risk score was the best predictor of cardiotoxicity with an AUC of 0.685 (CI 95% bootstrap: 0.625–0.743).

Discussion
Classic cardiovascular risk factors alone, or in combination with the proposed cancer treatment cannot adequately predict cardiotoxicity risk. The Mayo Clinic Cardiotoxicity Risk score outperformed the ASCO risk score but requires further refinement to enhance adequate cardiovascular risk prediction. For future model building, we hypothesize that an all-comer population of oncological patients should be used as a derivation cohort, regardless of previous or current cardiac issues, risk factors or type of therapy. Admittedly, individual susceptibility due to genetic, epigenetic and environmental predisposition cannot be adequately incorporated into a risk score and emphasizes the need for individual cardiotoxicity risk evaluation using bed to bench tools such as the use of induced pluripotent stem cell derived cardiac or vascular cells to assess the susceptibility of individual patients to cancer drug-induced cardiovascular toxicities. In the absence of adequate risk prediction tools, we advocate standardized screening of all patients before oncological treatment starts.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Cardiotoxicity
Prognostic value of self-reported subjective exercise capacity in patients with acute dyspnea
Authors: Belkin M , Wussler D , Michou E , Strebel I , Kozhuharov N , Sabti Z , Nowak A , Shrestha S , Lopez-Ayala P , Albus M B , Danier I , Simmen C , Diebold M , Breidthardt T , Mueller C ,   Cardiovascular Reasearch Institute Basel
Published: October 2021

Abstract

Background
Quantitative assessment of self-reported exercise capacity as provided by the Duke Activity Status Index (DASI) is a validated measure of exercise capacity in stable ambulatory patients.

Objectives
This study aimedto test whether the quantification of self-reported exercise capacityusing the DASI may aid physicians in the risk stratification of patients presenting with acute dyspnea to the emergency department (ED).

Methods
Basics in Acute Shortness of Breath EvaLuation (BASEL V) was a prospective cohort study recruiting dyspneic patients at the ED. The prognostic value and accuracy of theDASI assessed shortly after presentation were quantified using Cox regression analyses and the Area under the curve (AUC).

Results
Among 1019 patients eligible for this analysis 529 (51.9%) had an adjudicated final diagnosis of acute heart failure, 75 (7.4%) and 297 (29.1%) patients died within 90 and 720 days after presentation. Unadjusted hazard ratios (HR) and multivariable adjusted hazard ratios (aHR) for 90-day and 720-day mortality increased continuously from the fourth (best self-reported exercise capacity) to the first DASI-quartile (worst self-reported exercise capacity). For 720-day mortality in the first quartile theHR was 9.1 (95%-CI 5.5–14.9) (aHR 6.1 [95%-CI 3.7–10.1]), in the second quartile 6.4 (95%-CI 3.9–10.6) (aHR 4.4 [95%-CI 2.6–7.3]), while in the third quartile the HR was 3.2 (95%-CI 1.9–5.5) (aHR 2.4 [95%-CI 1.4–4.0]). The prognostic accuracy of the DASI was moderate-to-high and higher than that of B-type natriuretic peptide (BNP) and NT-proBNP (N-terminal pro-BNP) concentrations, e.g. for 720-day mortality prediction AUC 0.70 versus 0.64, p=0.020; 0.72 versus 0.68, p=0.074.

Conclusions
Quantification of self-reported subjective exercise capacityusing the DASI provides moderate-to-high prognostic accuracy in patients presenting with acute dyspnea to the ED and may aid physicians in further risk stratification.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): European Union, the Swiss National Science Foundation. Duke Activity Status Index
Sex-related differences in mortality following an admission for acute heart failure across left ventricular ejection fraction spectrum
Authors: Santas Olmeda E , Palau P , De La Espriella R , Minana G , Soler M , Lorenzo M , Nunez G , Chorro F J , Nunez J 
Published: October 2021

Abstract

Background
Prognosis in heart failure (HF) may differ between women and men. However, data is conflicting and sex-related differences in prognosis may be determined by left ventricular ejection fraction (LVEF) status. We sought to evaluate the prognostic differences between women and men with HF following an admission for acute HF (AHF).

Methods
We included 4,812 patients consecutively admitted for AHF in a multicenter registry from 3 hospitals in Valencia (Spain). Study endpoints were all-cause, cardiovascular (CV), and HF-related mortality at 6-months follow-up. Multivariable Cox regression models were fitted to investigate sex-related differences across LVEF status.

Results
2,243 (46.6%) patients were women and 2,569 (53.4%) were men. 2,608 (54.2%) patients had HF with preserved ejection fraction. At 6-months follow-up, 645 patients died (13.4%), being 544 (11.3%) and 416 (8.6%) CV and HF-related deaths, respectively. LVEF was not independently associated to mortality risk (HR=1.02; 95% CI 0.99–1.05; p=0.135). After multivariate adjustment, we found no sex-related differences in all-cause mortality (p-value for interaction=0.168). However, a significant interaction between sex and the risk of CV and HF mortality was found across LVEF status (p-value for interaction= 0.030 and 0.007; respectively). Compared to men, women had a significant lower risk of CV-mortality and HF-mortality at LVEF&lt;25% and &lt;42%, respectively. On the contrary, women showed a higher risk of HF-mortality at the upper extreme of LVEF (&gt;75%) (Figure, panel A and B).

Conclusions
Following an admission for AHF, no sex-related differences were found in the risk of all-cause mortality. However, compared to men, women showed a lower risk of CV and HF-mortality at the lower extreme of LVEF. On the contrary, they showed a higher risk of HF-death at the upper extreme.

Funding Acknowledgement
Type of funding sources: None.
Follistatin-like 3 (FSTL3) levels are increased in acute heart failure patients
Authors: Chen D , Untaru R , Liu S , Assadi-Khansari B , Croft A , Kelly C , Ajaero C , Chua S J , Boyle A J , Horowitz J D , Ngo D , Sverdlov A ,   Cardiovascular Team/ Hunter Medical Research Institute
Published: October 2021

Abstract

Introduction
Follistatin-like 3 (FSTL3) is a secreted protein that has been suggested to play an important role in modulating cardiac remodeling and hypertrophy. In this study, we aim to determine whether: 1) FSTL3 is incrementally elevated in patients with HF vs those with other cardiovascular disease (CVD); and 2) increased FSTL3 is associated with 2 or more hospital admissions due to major adverse CV events (MACE) within 1 year.

Methods and results
We measured circulating levels of FSTL3 using commercially available ELISA (R&D systems) in a total of n=696 patients. FSTL3 levels were compared between: 1) healthy-aging volunteers with no prior major CVD (n=267, age 67±6 years) and 2) patients admitted to cardiology unit for various CVD (n=429, age 66±14 years); among those (n=178, age 68±13 years) had HF. Patients with HF had 2-fold higher FSTL3 levels vs healthy age-matched controls vs those with other CVD (p&lt;0.001). Occurrences of MACE were recorded up to 1 year for patients admitted to cardiology unit. On univariate analyses, patient with 2 or more MACE within 1 year (n=91, 27%) had significant elevated FSTL3 levels (P=0.003), is associated with older age (P&lt;0.005). On multivariate analysis, high FSTL3 levels (P=0.034) is an independent predictor of 2 or more MACE admissions within 1 year after adjusting for age, clinical comorbidities and medications.

Conclusions
FSTL3 is incrementally increased in patients with HF and is associated with poorer prognosis. Elevated FSTL3 levels is associated with increased risks of cardiac hospital readmissions for patients with multiple CV morbidities.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): NSW Ministry of Health EMC Fellowship (Australia)
Stroke volume but not ejection fraction predicts prognosis in acute heart failure
Authors: Barki M , Losito M , Caracciolo M M , Bandera F , Rovida M , Alfonzetti E , Guazzi M 
Published: October 2021

Abstract

Background
Heart failure (HF) patients are categorized according to left ventricular ejection fraction (LVEF), being such index both easily feasible and prognostic. However, the risk stratification of patients hospitalized for acute decompensated heart failure (ADHF) according to the absolute value of LVEF at presentation is unexplored and its prognostic significance has not been tested against stroke volume indexed (SVi).

Purpose
To examine the prognostic impact of SVi versus LVEF in patients hospitalized for ADHF (wet and warm phenotype).

Methods
Eighty-five ADHF patients (mean age 75.6±10.4 years, 59% males) were prospectively enrolled within 24–48 hours from admission to the emergency department. In the acute phase all patients underwent a complete transthoracic echocardiography (TTE) and lung ultrasonography (LUS) associated with blood sample and a thorough clinical examination. Patients were then stratified into two groups according to the presence or the absence of a preserved SVi at admission (SVi ≥35 ml/m2).

Results
During a median follow-up (FU) time of 12 months (IQR months 8–15 months) we observed a CV event rate of 28.2%. During the FU period 14 patients (16.5%) were re-hospitalized for ADHF, 7 patients died for CV reason (8.2%), 1 patient underwent mitral valve replacement for severe chronic mitral regurgitation, 1 patient was re-hospitalized for cardiac resynchronization therapy and 1 subject was re-hospitalized for acute coronary syndrome.
Interestingly, patients that had a preserved TTE-derived SVi at admission (SVi ≥35 ml/m2) exhibited a significantly higher survival, when compared to subjects that showed an impairment of cardiac output at rest (SVi &lt;35 ml/m2) (log-rank: HR 5.5 CI 95% 2.1–14.3; p=0.04) (Figure 1). On the other hand, LVEF was not independently associated with the endpoint and HFrEF, HFmrEF and HFpEF patients showed a comparable median survival (Figure 2).

Conclusions
Although the categorization of LVEF in CHF patients bears a pivotal classificatory and prognostic role, its assessment in ADHF, may lack of prognostic value especially when compared to SVi which represents a better parameter to define high-risk subjects who benefit from closer monitoring.

Funding Acknowledgement
Type of funding sources: None.