bluuebunny/crossref_metadata_2025_split huggingface dataset:
In hospital mortality and outcomes of patients with acute decompensated diastolic heart failure with and without amyloidosis
Authors: Murthi M , Sharma B , Velagapudi S , Atluri R , Velazquez G , Wahab A 
Published: October 2021

Abstract

Introduction
The incidence of heart failure has exponentially increased over the last few decades and acute decompensated diastolic heart failure is one of the leading causes of hospitalization and readmission. Cardiac amyloidosis is one of the rapidly progressing heart conditions. It occurs due to amorphous proteinaceous material called amyloid into the extracellular space of the heart. The infiltration of the heart from amyloid protein has a broad spectrum of presentation, including diastolic heart failure.

Purpose
Heart failure due to amyloidosis is characterized by diastolic dysfunction resulting from restrictive cardiomyopathy. The outcomes of hospitalized patient with acute decompensated diastolic heart failure in amyloidosis patients compared to those without amyloidosis is not well defined.

Methods
We conducted a retrospective cohort study by utilizing the National Inpatient sample database from 2017. Using International Classification of disease (ICD)-10 codes, patients with the diagnosis of acute and acute on chronic diastolic heart failure were enrolled in the study. They were further stratified based on the presence of amyloidosis. The primary outcome was to measure in-hospital mortality, while secondary outcomes included development of acute kidney injury (AKI), Acute respiratory failure (ARF), shock and arrhythmias.

Results
Out of the 915,694 patients with Acute Decompensated diastolic heart failure, about 2270 had amyloidosis as secondary diagnosis. 6.1% of ADHF and amyloidosis died in hospital, compared to 4.2% in those without amyloidosis (aOR=1.35 CI=0.89–2.05, p=0.197). On multivariate analysis, patients with Amyloidosis had increased odds of developing AKI (aOR=1.40 CI 1.13–1.72, p=0.001), Cardiogenic shock (aOR=2.67 CI 1.56–4.55, p&lt;0.001) and arrhythmias (aOR=1.34, CI 1.10–1.64, p=0.004). The incidence of ARF was however lower in patients without amyloidosis compared to those with it (aOR=0.60, CI 0.47–0.75, p&lt;0.001).

Conclusion
Amyloidosis is one of the underappreciated and underdiagnosed causes of heart failure. Our study shows an increased risk of complications in acute decompensated heart failure with the presence of amyloidosis. Thus, physicians must be aware of this clinical entity for early diagnosis as patients with advanced disease are likely to have poor prognoses.

Funding Acknowledgement
Type of funding sources: None.
Vericiguat and health status outcomes in heart failure with reduced ejection fraction: insights from the VICTORIA trial
Authors: Butler J , Stebbins A , Melenovsky V , Sweitzer N , Cowie M.R , Stehlik J , Ezekowitz J.A , Hernandez A.F , Lam C.S.P , Nkulikiyinka R , O'Connor C.M , Pieske B , Ponikowski P , Voors A.A , Armstrong P.W ,   the VICTORIA Study Group
Published: October 2021

Abstract

Background
In the VICTORIA trial, vericiguat compared with placebo reduced the risk of the primary endpoint of cardiovascular death (CVD) or hospitalization for heart failure (HFH) among 5050 patients with worsening HF with reduced ejection fraction (HFrEF).

Purpose
We evaluated whether the efficacy of vericiguat on clinical outcomes varied according to participants' baseline health status, as assessed by the Kansas City Cardiomyopathy Questionnaire (KCCQ)-23, and how vericiguat affected health status post-randomization.

Methods
KCCQ-23 was completed at randomization and at 4, 16, and 32 weeks. Patients were grouped based on tertiles of baseline KCCQ total symptom score (TSS; &lt;55.2, 55.2–79.2, and &gt;79.2), clinical summary score (CSS; &lt;52.1, 52.1–76.0, and &gt;76.2) and overall summary score (OSS; &lt;48.5, 48.5–70.8, and &gt;70.8) across tertiles 1–3, respectively. Cox proportional hazard models were performed for the tertiles to evaluate the effects of vericiguat on the primary outcomes.

Results
Overall 4741, 4664, and 4470 participants had KCCQ-TSS (median 68.8 [interquartile range 47.9, 85.4]), KCCQ-CSS (65.6 [45.8, 81.8]) and KCCQ-OSS (59.9 [42.0, 77.1]) available at baseline. Vericiguat reduced CVD or HFH risk across baseline KCCQ-TSS (P=0.21), KCCQ-CSS (P=0.13) and KCCQ-OSS (P=0.65) tertiles (Table). The effect of vericiguat on HFH alone was also not modified by baseline KCCQ-TSS, CSS and OSS (all P&gt;0.05) scores. At 4 weeks after randomization, improvement in both vericiguat and placebo arms was seen in KCCQ-TSS (vericiguat 6.3 vs. placebo 6.3; P=0.85), KCCQ-CSS (vericiguat: 5.7 vs. placebo 5.7, P=0.54), and KCCQ-OSS (vericiguat 6.3 vs. placebo 5.7, P=0.36). Similar results were seen at weeks 16 and 32.

Conclusion
Vericiguat reduced the risk of the composite outcome of CVD or HFH as well as HFH alone across the range of baseline health status. Addition of vericiguat to best standard of care did not significantly improve health status compared with standard of care alone in HF patients with a recent worsening event. The early improvement in KCCQ seen in both randomized groups underscore the need to assess trajectory of health status changes in the spectrum of patients with HFrEF.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Merck & Co., Inc. and Bayer
Resting and exercise hemodynamic determinants of daily activity measured by accelerometer in stable heart failure patients
Authors: Omar M , Jensen J , Frederiksen P , Videbaek L , Kjaer Poulsen M , Christian Broend J , Gustafsson F , Borlaug B , Schou M , Eifer Moeller J 
Published: October 2021

Abstract

Background
Patient-worn accelerometer is increasingly used in patients with heart failure and reduced ejection fraction (HFrEF) to assess daily activity and and as surrogate endpoint. We examined the association between cardiac physiology and daily activity by patient-worn accelerometer recordings in stable HFrEF patients.

Methods
In this descriptive study, physical average daily accelerometer units (PADA) and total average daily accelerometer unit (TADA) were assessed by a accelerometer recordings. Sixty three stable ambulatory patients with HFrEF, mainly men (92%), mean age 58±10 years, and ejection-fraction 26±4% underwent hemodynamic exercise testing, and accelerometry (Table 1). Patients were divided by PADA in a low and high activity level groups based on counts per minute physical activity.

Results
Patients in the low activity group were older and more frequently treated with diuretics. At rest, the low activity group was characterized by a lower cardiac index (CI) (2.2±0.4 vs. 2.4±0.4 l/min/m2, p=0.01), Stroke volume (SV) (70±19 vs. 81±17 ml, p=0.02) but not pulmonary capillary wedge pressure (PCWP) (12±5 vs. 11±5 mmHg, p=0.3) (Figure 1). Low activity group reached a lower CI (4.8±1.7 vs. 6.6±1.7 l/min/m2, p&lt;0.001) and SV (94±32 vs. 121±29 ml, p&lt;0.001), but not in PCWP (31±12 vs. 27±8 mmHg, p=0.2) or arterial-venous O2 content difference (A-VO2 diff) (13.00±2.32 vs. 12.96±1.65 ml O2/dl, p=0.9) at peak exercise. The attenuated increase was associated with attenuated increase in SV rther than increase in heart rate (42±23 vs. 52±21 bpm, p=0.07). Finally, CI at peak exercise was the only independent variable associated with PADA after adjusting for age, gender, and BMI (p&lt;0.0001). The PADA and TADA were associated to functional assessments using Kansas City Cardiomyopathy Questionnaire, but not with New York Heart Association class or N-terminal pro brain natriuretic peptide (NT-proBNP) (Table 1).

Conclusion
Accelerometer-assessed activity in patients with HFrEF are associated with impairments in LV performance, SV reserve and cardiac output during exercise, to a greater extent than changes in arterial-venous O2 content difference or pulmonary vascular pressures. Accelerometer data may provide information about the functional status that we do not nessecary find in the widely used tools in both research and daily clinical practice.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): This work was supported by the Danish Heart Foundation [grant numbers 17-R116-A7714-22076, 18-R124-A8573-22107]; Steno Diabetes Center Odense, Denmark [grant number 3363] and A.P. Møller Foundation for the Advancement of Medical Science [grant number 17-L-0339]. Table 1. Baseline and regression analysisFigure 1. Change in PCWP and CI by exercise
Chronic ischemic heart failure in humans is associated with changes in expression of antigen processing HLA types and activation of T-cells
Authors: Merten M , Rasper T , Schuhmacher B , Cremer S , Zeiher A.M , Hoffmann J , Abplanalp W , Dimmeler S 
Published: October 2021

Abstract

Background
Sustained pathological inflammation is a hallmark of chronic ischemic heart failure (HF). The short term response to myocardial ischemia has found a protective phenotype for T regulatory cells, yet the extent and consequence of prolonged T-cell activation in chronic ischemic heart failure is unclear.

Methods and results
Single cell RNA sequencing of circulating immune cells (n=181,712 cells) from healthy (n=8) and heart failure donors (n=8) revealed a relative increase in the proportion of activated T cells in heart failure patients relative to healthy controls. T cell activation molecules of the HLA-DR series genes on antigen presenting cells were found to be strongly associated with heart failure patients in the sequencing data, with decreases in antigen processing genes (HLA-DM series) in heart failure patients. Validation via flow cytometry in 27 healthy controls and 43 heart failure patients showed relative decreases of greater than 30% for HLA-DM to HLA-DRB molecule ratios in HF patients (p=0.0082), suggesting an aberrant antigen presentation to T cells linked to autoimmunity in heart failure patients. Additionally, costimulatory molecules such as ICAM-1 (p=0.004) and activation markers like TREM-1 (p=0.04) were elevated in circulating monocytes cells, which may potentiate T cell activation. Correspondingly, a significant and striking decrease in CD4+ and CD8+ naïve T cells along with increases in combined effector memory and TEMRA cells could be evidenced in heart failure patients. Levels of the T-cell homing marker CCR5 were elevated in patients with heart failure. To gain additional insights into potential functional consequences in the heart, supernatants from 3h LPS stimulated immune cells (peripheral blood mononuclear cells or T cells) were applied to various vascular cell types (endothelial cells, pericytes) and with cardiac organoids for 48h. Apoptosis was increased more than 3 fold following incubation with media derived from peripheral blood cells of HF patients, suggesting that immune cells from heart failure patients can directly and indirectly impair cardiovascular cells.

Conclusion
Heart failure is marked by sustained increases in relative proportions of effector T cell and TEMRA populations and homing markers suggesting these cells may undergo extravasation to tissues and deteriorate inflamed myocardium - hastening heart failure progression, worsening prognosis. Further research is required to assess how these cells may migrate to myocardial tissues and what interventions could be useful for blocking myocardial damage.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DZHK, DGK, SFB
Examination about more realistic prognosis evaluation method, how long the patients with congestive heart failure can spend at home
Authors: Takaishi A , Iida T , Kishinoue T , Mori H , Yamaji T , Tanimoto M , Onishi N , Hirohata S , Ueeda M , Ito H 
Published: October 2021

Abstract

Background
From August 2015, for efficient medical care in congestive heart failure (CHF) cases, we had introduced a unique clinical pathway (PATH) provided the immediate use of Tolvaptan and comprehensive education by multi-disciplinary staff after admission. And by introduction of PATH, we confirmed the shortening effect of hospitalization period with CHF and the suppressive effect of readmission with CHF after discharge. But since almost CHF patients repeat hospitalization and discharge due to change of their medical condition, the investigation for only first readmission rate after discharge is not enough to assess the entire long clinical course of CHF. Recently we found one report about evaluation method for CHF clinical prognosis, how long CHF patients can stay healthy at their own home after discharge within a certain period. This evaluation method is considered to take into account the long clinical course of CHF.

Purpose
We investigated whether the CHF patients introduced PATH on admission could stay longer at their home than CHF patients without PATH.

Methods
Between April 2014 and July 2019, 471 CHF cases, who ware admitted in our hospital at first and could be followed up for at least 1 month after discharge, ware enrolled. We divided them to two groups, PATH- group before introducing PATH (until July 2015, 142 cases), and PATH+ group applied PATH (after August 2015, 329 cases). Between both groups, we investigated the readmission rate (RR) with CHF and the total period (TP) that patients could spend at home within1, 3, 6 and 12month after discharge.

Results
There were no significant differences in mean age, pre-hospital living status, or clinical status at admission between the two groups. On the other hand, due to efficient CHF care, the average length of hospital stay was significantly shorter (figure1). RR within 1, 3, 6 and 12 months after discharge ware all lower in PATH+ group. And TP within 1, 3, 6 and 12 months after discharge ware all longer in PATH+ group (figure2).

Conclusion
By introducing our unique clinical pathway for congestive heart failure cases requiring hospitalization, we could confirm not only the improvement of their conventional clinical prognosis index but also the improvement of their new and more realistic clinical prognosis index after discharge.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Cognitive impairment is a determinant of patient response to disease management programs to reduce readmission in heart failure
Authors: Huynh Q , Negishi K , Depasquale C , Hare J , Leung D , Stanton T , Marwick T 
Published: October 2021

Abstract

Background
Cognitive impairment (CI) is highly prevalent in heart failure (HF), and increases patients' risks of readmission.

Purpose
This study sought to determine whether the presence and degree of CI could identify patients most likely to benefit from a HF disease management program (DMP) to reduce readmissions.

Methods
1152 consecutive Australian patients admitted with HF (2014–17) were prospectively followed-up for 12 months. Of these, 324 patients who received DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review) were matched (1:2 ratio) with 648 usual care patients. Cognitive function was assessed either on the day of or one day before discharge using the Montreal Cognitive Assessment (MoCA). Outcomes included readmission or death at 1-, 3- and 12-months, and days-at-home within 12 months, from discharge.

Results
Poorer cognitive function was associated with all adverse outcomes. Compared with usual care, DMP was associated with lower odds of 30-day (OR=0.60 [0.40, 0.91]) and 90-day (OR=0.53 [0.36, 0.77]) readmission or death, and with 19 more days-at-home within 12 months, independent of HF therapy. The effect sizes of these associations were greater for patients with diminished cognition than those with normal cognition (interaction p=0.036), and might have been more pronounced among those with mild CI compared with those with more severe CI (MoCA score 17–22, OR=0.42 [0.21, 0.87] at 30-day, OR=0.31 [0.16, 0.60] at 90-day). Patients with normal cognition had fewer events, irrespective of DMP.

Conclusions
Cognitive function may determine how HF patients respond to a DMP. Cognitive screening before implementation of a DMP may allow personalized plans for patients with different levels of cognitive function

Funding Acknowledgement
Type of funding sources: None.
Risk stratification and survival in patients with HFmrEF: the role of cardiopulmonary exercise testing
Authors: Westphal J.G , Schulze P.C 
Published: October 2021

Abstract

Background
The prognostic value of cardiopulmonary exercise testing (CPET) is established for risk stratification in patients with heart failure (HF) and reduced ejection fraction (HFrEF). Since the introduction of HF with mid-range ejection fraction (HFmrEF) as an additional category in 2016, optimal management strategy and risk stratification for these patients is a field of ongoing research.

Purpose
Left ventricular ejection fraction (LVEF) is only one part of the picture when planning treatment and estimating long time risk for patients with HF. We planned to investigate the predictive long-term value of exercise intolerance as measured by CPET in patients with HFmrEF in comparison to HFrEF.

Methods
We performed a single-center retrospective cohort study of ambulatory consecutive patients that showed signs of heart failure (NYHA functional class II or III) and had a LVEF of 49% or below as measured by echocardiography at the time of CPET. All patients underwent CPET evaluation with an upright bicycle between 2015–2017. The primary endpoint of all-cause mortality as well as the secondary composite endpoint of all-cause mortality or heart transplant/ventricular assist device implantation (transplant/VAD free survival) were assessed.

Results
For the primary analysis, 253 patients (mean age 61.2±13.0 years, 82.6% male) were included. 68 patients showed an LVEF between 40 and 49% (HFmrEF) whereas 185 patients had an LVEF of below 40% (HFrEF). HF etiology was in 31.3% ischemic. Mean BNP values were 788±1061 pg/ml while HFmrEF patients had on average lower values than HFrEF (322±676 vs. 945±1121, p&lt;0.001). Patients were followed up for a median of 4.2 years (IQR: 3.5–5.0 years). Over this period, the primary and secondary end-point occurred in 22.5%/30.8% of patients.
Patients in the HFmrEF group showed a higher mean peak oxygen uptake compared to HFrEF (pVO2; 17.3±4.6 vs 14.2±3.7 ml/min/kg, p&lt;0.001), peak exercise power (Pmax; 111±49 vs 91±38 Watt, p=0.02) and peak oxygen pulse (pO2/HR; 12.6±4.2 vs 10.4±4.1 ml/min/kg, p&lt;0.001). The Kaplan-Meier-Estimate showed a significant difference in survival for both HFmrEF and HFrEF who had pVO2 below 14 ml/min/kg (Log Rank: Chi2: 4.45, p=0.035 and Chi2: 10.05, p=0.02). In univariate Cox regression, pVO2 was predictive of the primary endpoint (HR per +1 mL/kg/min: 0.81; CI: 0.71–0.93; p=0.002 and HR per +1 mL/kg/min: 0.84; CI: 0.77–0.92; p&lt;0.001) in both groups as was Pmax and pO2/HR (p&lt;0.05 for both variables in both groups).

Conclusion
As in HFrEF, CPET is a useful tool to stratify risk in HFmrEF as well. Our findings support the prognostic role of pVO2 as well as pO2/HR and Pmax in HF with mid-range LVEF. Using a cut off of pVO2 14 ml/min/kg selected patients at risk with similar long-term prognosis as in the HFrEF cohort. Further research to identify subgroups at risk within the heterogeneous group of HFmrEF is warranted for optimal risk stratification.

Funding Acknowledgement
Type of funding sources: None.
The validity of heart failure diagnoses at hospital-discharge and ambulatory evaluation visits: insights from two Norwegian local hospitals
Authors: Ofstad A.P , Johansen O.E , Brunborg C , Morkedal B , Fagerland M.W , Laugsand L.E , Gullestad L , Dalen H 
Published: October 2021

Abstract

Background
The validity of heart failure (HF) diagnoses made in hospitals has been debated and low positive predictive values (PPV) may represent a bias in epidemiological research.

Purpose
To validate primary and secondary HF diagnoses at discharge or during ambulatory evaluation in general hospitals aiming to obtain confirmed HF diagnoses to develop a HF-prediction risk score.

Methods
We extracted data on all patients with a HF diagnosis by ICD-10 codes (I50 HF, I42 cardiomyopathy and I11 hypertension with HF) in any position from the hospitals' electronic medical records from Oct. 2006 to Dec. 2018. One experienced cardiologist scrutinized all journals for events being either a valid HF event, unlikely, or uncertain due to lacking information, according to the 2016 ESC HF guidelines. In cases where first event was unlikely or uncertain subsequent events were judged for valid HF.

Results
A total of 3411 patients with at least one HF diagnosis were assessed (mean age 79.7±10.6 yrs, 49.1% men); 3089 after in-hospital stays and 322 after ambulatory consultations. Overall, 2174 were deemed as valid HF diagnosis with a PPV of 63.7%; PPV was higher when HF diagnosis was based on in-hospital diagnoses and when HF was the primary diagnosis (Table).

Conclusions
Only 64% of all HF diagnoses were likely HF according to present guidelines, with higher precision for in-hospital diagnoses and HF in the primary position. This underscores the importance to use validated HF-diagnoses for HF prediction risk score development.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Boehringer Ingelheim Norway KS
Correlation between invasive and non-invasive quantification of myocardial amyloid load in cardiac transthyretin amyloidosis
Authors: Ungericht M , Groaz V , Messner M , Zaruba M.-M , Doerler J , Lener D , Stocker E.-M , Mayr A , Kroiss A , Poelzl G 
Published: October 2021

Abstract

Background
Cardiac transthyretin (ATTR) amyloidosis is an infiltrative disease caused by the extracellular deposition of misfolded ATTR protein in the myocardium. Early disease recognition and accurate description of cardiac involvement are fundamental, as cardiac ATTR amyloidosis is associated with poor prognosis. Although endomyocardial biopsy (EMB) remains the gold standard in amyloid detection and typing, non-invasive imaging can provide an accurate diagnostic tool. Bone scintigraphy enables early disease detection with high accuracy. However, it remains to be determined whether the degree of cardiac tracer uptake on bone scintigraphy correlates with the extent of histologic amyloid burden in EMB.

Aim
This single center observational study aimed to compare the histological amyloid load in endomyocardial biopsies with the quantification of cardiac tracer uptake on 99mTechnetium-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) scintigraphy in cardiac ATTR amyloidosis.

Methods
23 patients with cardiac ATTR amyloidosis were enrolled. Diagnosis was obtained with a combination of invasive and non-invasive methods. Perugini score, mean left ventricular tracer uptake (LV uptake) and left ventricular to corpus sterni uptake ratio (LV/CS ratio) on 99mTc-DPD-scintigraphy were measured, while histological amyloid load was quantified as percentage of the analysed myocardial tissue using Sulfated Alcian Blue staining and the Fiji-ImageJ programme. Bivariate correlation and Pearson correlation coefficient were used to study the relationship between EMB and 99mTc-DPD-scintigraphy findings.

Results
We found a statistically significant correlation between histological amyloid load and Perugini score (r=0.47 p=0.02), as well as between Perugini score and LV/CS ratio (r=0.31 p=0.046). Mean LV tracer uptake showed a trend for correlation with histological amyloid load (r=0.37 p=0.08), without reaching statistical significance.

Conclusion
We found a correlation between the extent of histologic amyloid burden in EMB and the degree of cardiac tracer uptake on 99mTc-DPD-scintigraphy. Our results underline the reliability of 99mTc-DPD-scintigraphy as a surrogate of histological amyloid load in the diagnosis of cardiac ATTR amyloidosis. Possible implications for the assessment of prognosis are subject to future studies with a larger number of patients.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Pfizer