bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of infective endocarditis in Hong Kong, 2000–2019
Authors: Li H L , Yu S Y , Tse Y K , Wu M Z , Ren Q W , Tse H F , Yiu K H 
Published: October 2021

Abstract

Background/Introduction
Despite improvements in diagnostic and therapeutic strategies, the mortality and morbidity of infective endocarditis (IE) remain high. The incidence, outcomes, and surgical intervention of IE, particularly in an Asian population, are poorly understood and characterised, and the effect of antibiotic prophylaxis guidelines revision on the incidence of IE remains unexplored.

Purpose
We aim to describe temporal changes in the epidemiology and surgical intervention for IE in Hong Kong in the past 2 decades.

Methods
From a well-validated territory-wide database in Hong Kong, all patients aged 20 or above diagnosed with incident IE from 2000–2019 were included. The temporal trends in the incidence of IE, rate of surgical intervention, and mean Charlson Comorbidity Index (CCI) were characterised using Poisson regression analysis and expressed in annual percentage change (APC [95% CI]). Interrupted time series analysis was used to evaluate the change in incidence after the revision of antibiotic prophylaxis guidelines. The association between surgical intervention and mortality was evaluated using propensity score analytics. Temporal trends in 1-year all-cause mortality were evaluated using multivariable Cox regression.

Results
A total of 5,657 patients (59.9±18.3 years, 37.2% females) were included. The crude incidence remained was stable from 2000 to 2019 (APC 0.1% [−0.5 to 0.7], P=0.675), and remained unchanged following the revision of antibiotic prophylaxis guidelines in 2008 (relative risk of change 0.90 [0.64 to 1.00], P=0.065) (Figure 1). Concordant with an increase in the mean age of IE patients (APC 0.9% [0.8 to 1.1], P&lt;0.001), the comorbidity burden grew substantially from 2000 (CCI 0.55±1.27) to 2019 (CCI 1.09±1.66).
The rate of surgical intervention significantly increased from 5.3% in 2000 to 17.8% in 2019 (APC 2.7% [1.1 to 4.3], P=0.004), and surgical intervention at 1 year was associated with a 45% risk reduction in 1-year all-cause mortality (Hazard Ratio 0.55 [0.46 to 0.65], P&lt;0.001). Nevertheless, the crude all-cause mortality rate at 1 year increased from 27.4% in 2000 to 31.5% in 2019, with no significant trend after adjustment for demographics and comorbidities (APC −0.7% [−1.6 to 0.1], P=0.087).

Conclusions
In this large cohort of Asian patients, the incidence of IE remained static and did not change following the revision of antibiotic prophylaxis guidelines. Over time, patients with IE have evolved to be older and more comorbid. Despite an increasing rate of surgical intervention that conferred improved survival, the mortality of IE remained irresistibly high.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Shenzhen Key Medical DisciplineThe Sanming Project of HKU-SZH Cardiology
Plasminogen activator inhibitor-1 (PAI-1) is anti-fibrogenic in human inflammatory cardiomyopathy
Authors: Baumeier C , Escher F , Pietsch H , Aleshcheva G , Schultheiss H P 
Published: October 2021

Abstract

Background/Introduction
Preclinical data indicate that plasminogen activator inhibitor-1 (PAI-1) is cardioprotective by repressing cardiac fibrosis through TGF-β and plasminogen mediated pathways. In addition it is linked to the recruitment and polarization of non-classical M2 macrophages in cancer.

Purpose
The role of cardiac PAI-1 in fibrogenesis and macrophage polarization is investigated in patients with dilated cardiomyopathy (DCM) and inflammatory dilated cardiomyopathy (DCMi).

Methods
We retrospectively analyzed endomyocardial biopsies (EMBs) of patients with DCM (n=27) and DCMi (n=149) for PAI-1 expression, number of activated myofibroblasts and M1/M2 macrophage polarization.

Results
Patients with high-grade DCMi (DCMi-high, CD3+ lymphocytes &gt;30 cells/mm2) had significantly increased PAI-1 levels compared to DCM and low grade DCMi patients (DCMi-low, CD3+ lymphocytes = 14 - 30 cells/mm2) (15.5±0.4% vs. 1.0±0.1% and 4.0±0.1%, p≤0.001). Elevated PAI-1 expression in DCMi-high subjects was accompanied by a reduced number of alpha smooth muscle actin (α-SMA) positive myofibroblasts and an increased number of CD16+ CD68+ M2 macrophages, indicating anti-fibrogenic and M2 macrophage-favoring properties of PAI-1 in DCMi.

Conclusion
Our findings give evidence that elevated expression of PAI-1 suppresses cardiac fibrosis and promotes M2 macrophage polarization. Thus, PAI-1 could serve as a potential prognostic biomarker of cardiac fibrosis and inflammation, as well as possible therapeutic target in inflammatory cardiomyopathies.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): ERA-Net on Cardiovascular Diseases (ERA-CVD) of the German Research Foundation (DFG)Transregional Collaborative Research Center “Inflammatory Cardiomyopathy-Molecular Pathogenesis and Therapy”
Serum autotaxin level predicts future cardiac events in patients with dilated cardiomyopathy
Authors: Araki T , Okumura T , Mizutani T , Kimura Y , Kazama S , Shibata N , Oishi H , Kuwayama T , Hiraiwa H , Kondo T , Morimoto R , Takefuji M , Murohara T 
Published: October 2021

Abstract

Background
Autotaxin (ATX) has been reported to promote myocardial inflammation and subsequent cardiac remodeling through lysophosphatidic acid (LPA) production. However, the prognostic impact of ATX has not been clarified in dilated cardiomyopathy (DCM).

Purpose
We aimed to investigate the prognostic impact of ATX in patients with DCM.

Methods
We enrolled 104 DCM patients (49.8 years, 76 males). The subjects underwent blood sampling, echocardiography, cardiac catheterization, and endomyocardial biopsy. Gender differences in serum ATX levels have been reported, thus we divided the subjects into two groups using median serum ATX levels for men and women: High-ATX group and Low-ATX group. All patients were followed up by expert cardiologists. The cardiac event was defined as a composite of cardiac death and hospitalization for worsening heart failure.

Results
Eighty-nine percent of the subjects were classified as New York Heart Association functional class I or II. Female patients had higher serum ATX levels than male patients, with median values of 257.0 ng/mL and 203.5 ng/mL, respectively (Figure A). The average left ventricular ejection fraction and brain natriuretic peptide levels were 30.6% and 122.5 pg/mL. In survival analysis, cumulative event-free probability was significantly lower in High ATX group (p=0.007, Figure B). In Cox proportional hazards analysis, High-ATX was one of the independent predictors of composite cardiac events (Hazards Ratio, 2.575; p=0.043). On the other hand, high sensitive C-reactive protein and collagen volume fraction in myocardial samples were not significant predictors.

Conclusion
High serum ATX level was associated with poor prognosis in patients with DCM.

Funding Acknowledgement
Type of funding sources: None. Gender difference in autotaxin levelsSurvival analysis of cardiac events
Neutrophil-to-lymphocyte ratio and monocyte-to-lymphocyte ratio predict length of hospital stay in acute myocarditis
Authors: Schmutzler L , Mirna M , Topf A , Hoppe U C , Lichtenauer M 
Published: October 2021

Abstract

Background
Neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR) are associated with the severity of various diseases, for example sepsis and coronary artery disease. So far, these ratios have not been described in patients diagnosed with myocarditis. The aim of this study was to demonstrate the relationship of NLR and MLR with the severity of acute myocarditis.

Materials and methods
224 consecutive patients with myocarditis were retrospectively enrolled in this study. Laboratory parameters and clinical data were extracted from hospital records and discharge letters.

Results
Median NLR was 2.48 (IQR 1.51–4.71) and median MLR was 0.42 (IQR 0.29–0.58). NLR and MLR correlated with HF, CRP and leukocyte count. NLR further correlated with pBNP (rs= 0.390, p=0.037) and inversely with oxygen saturation (rs=−0.620, p=0.042), whereas MLR correlated inversely with LV systolic function (rs=−0.386, p=0.018). Both ratios correlated better with length of hospital stay (NLR: rs= 0.450, p=0.001, MLR: rs= 0.547, p&lt;0.0001) than CRP, leukocyte count, troponin, CK or pBNP. In multiple linear regression analysis, a model with eGFR and MLR achieved the best predictive ability for length of stay (adj. R2= 0.61, p&lt;0.0001). AUCs for the prediction of prolonged hospital stay (NLR= 0.79, MLR= 0.82), and optimal cut-offs therefor were calculated (NLR= 4.00 (sens.: 68%, spec.: 84%), MLR= 0.48 (sens.: 79%, spec.: 78%)). Patients who met the combined endpoint of in-hospital complications showed a higher NLR, however, this remained statistically insignificant (NLR: median 3.59 (IQR 1.60–10.13) vs. 2.49 (IQR 1.51–4.60), p=0.288).

Conclusion
NLR and MLR correlated with the length of stay, as well as with several clinical and laboratory parameters in patients with myocarditis. Since white blood cell differentials are relatively easy and fast to perform, both ratios could facilitate further risk stratification in patients with acute myocarditis.

Funding Acknowledgement
Type of funding sources: None.
Does age influence follow-up after alcohol septal ablation in hypertrophic obstructive cardiomyopathy?
Authors: Batzner A , Aicha D , Pfeiffer B , Neugebauer A , Seggewiss H 
Published: October 2021

Abstract

Introduction
Hypertrophic cardiomyopathy (HCM) is the most common genetic cardiac disease. Since its introduction in 1995 alcohol septal ablation (PTSMA) was discussed as treatment option only in elderly patients with symptomatic obstructive HCM (HOCM). We report on long-term follow-up after PTSMA with respect to patient's age.

Methods and results
Between 5/2000 and 6/2017 we treated 952 consecutive symptomatic HOCM patients (pts) with first PTSMA in our center. 132 (13.9%) pts were &lt;40 years of age (Group A; mean age 30.3±7.7), 421 (44.2%) pts between ≥40 to &lt;60 years of age (Group B; mean age 50.5±5.9) and 399 (41.9%) pts ≥60 years of age (Group C; 69.6±6.3). Family history (FH) of HCM was more often seen in Group A (50% vs. 25.7% (B) and 13.3% (C); p&lt;0.ehab724.17611) as FH of sudden cardiac death (SCD) (17.4% vs. 11.2% (B) and 7.0% (C); p&lt;0.01). Pts in Group C were more often in NYHA class III/IV (80.7%; p&lt;0.001 each) compared to Group A (68.2%) and B (67.9%). At the time of PTSMA an ICD for primary SCD prevention had been more often implanted in Group A (19.8%; p&lt;0.0001) compared to Group B (10.1%) and C (5.9%).
Echocardiographic measurements showed higher maximal septal thickness in Group A (23.9±5.7 mm; p&lt;0.ehab724.17611 each) compared to Group B (20.9±4.0 mm) and C (20.1±3.5 mm). Pts of Group B had lower resting gradients (60.0±35.3 mmHg; p&lt;0.01 each) compared to Group A (69.5±34.8 mmHg) and C (66.4±41.6 mmHg). Total heart block at PTSMA was less often seen in Group A (28.8%; p&lt;0.05 each) compared to Group B (39.4%) and C (43.4%). Due to persistent total heart block need of permanent pacemaker implantation was lowest in Group A (3.8%, p&lt;0.01 each) compared to Group B (9.3%) and C (14.0%) during hospital stay. One patient in Group A and C died during hospital stay, each.
Follow-up was longer in Group A (6.7±5.2 years) compared to Group C (5.5±4.8 years; p&lt;0.05) and was comparable to Group B (6.2±5.1 years). Re-PTSMA was more often performed in Group A (22.7%; p&lt;0.01 each) compared to Group B (12.8%) and Group C (10.5%). Reported clinical improvement at latest follow-up was comparable (93.3% Group A, 93.8% Group B, and 95.5% Group C). Mortality was highest in Group C (12.5%; p&lt;0.0001 each) compared to Group A (1.5%) and B (4.0%). In Group A no pt died from cardiac reason, whereas 5 pts died from cardiac reasons in Group B and C, each. SCD was not observed in Group A, whereas 2 pts in Group B and 1 pt in Group C suffered SCD.

Conclusion
PTSMA is feasible even in young pts with symptomatic HOCM. Mortality after PTSMA is mainly due to non-cardiac reasons and more often seen in elderly pts. Especially, SCD could be observed in younger pts &lt;40 years of age.

Funding Acknowledgement
Type of funding sources: None.
Clinical effects of metoprolol in obstructive hypertrophic cardiomyopathy (TEMPO). A randomized, double-blinded, placebo-controlled crossover trial
Authors: Dybro A M , Rasmussen T B , Nielsen R R , Andersen M J , Jensen M K , Poulsen S H 
Published: October 2021

Abstract

Background
Treatment with beta blockers (BB) has been used for symptomatic relief in patients with obstructive hypertrophic cardiomyopathy (HCM) for decades. Even so, the guideline recommendation for the use of BB rests on expert opinions and observational cohort studies. Providing comprehensive high-quality data on the effects of BB in obstructive HCM is essential, especially in the context of newly developed pharmacological treatment strategies specifically targeting this disease (1).

Purpose
The study aimed to investigate the effects of metoprolol on left ventricular outflow tract (LVOT) obstruction, symptoms, and exercise capacity in patients with obstructive HCM.

Methods
This double-blinded, placebo-controlled, randomized crossover trial enrolled 30 patients with obstructive HCM and New York Heart Association (NYHA) class ≥ II symptoms from 1 May 2018 to 1 September 2020. Patients received metoprolol or placebo for two consecutive two-week periods in random order. The effect parameters were LVOT gradients, NYHA class, Canadian Cardiovascular Society (CCS) grading angina class, Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OSS), and cardiopulmonary exercise testing.

Results
Compared with placebo, the LVOT gradient during metoprolol was lower at rest (25 [15–58] mmHg versus 72 [28–87] mmHg; p=0.007), at peak exercise (28 [18–40] mmHg versus 62 [31–113] mmHg; p&lt;0.001), and post-exercise (45 [24–100] mmHg versus 115 [55–171] mmHg; p&lt;0.0001) (figure 1). During metoprolol treatment, 14% of patients were in NYHA class III compared with 38% on placebo (p&lt;0.01). Likewise, no patients were in CCS class ≥ III during metoprolol compared with 10% during placebo (p&lt;0.01). These findings were confirmed by a higher KCCQ-OSS score during metoprolol (76.2 (16.2) versus 73.8 (19.5), p=0.039) (figure 2). Peak oxygen consumption did not differ between study arms.

Conclusion
Compared with placebo, metoprolol reduced LVOT obstruction at rest and during exercise, provided symptom relief, and improved quality of life in patients with obstructive HCM. However, exercise capacity remained unchanged. Findings from the present study support the guideline recommendations that BB should be the first drug of choice in patients with obstructive HCM who develop symptoms.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Novo nordic foundation, Skibsreder Per Henriksen, R. og hustrus Foundation
Prevalence of cardiac amyloidosis in patients with unexplained left ventricle hypertrophy
Authors: Holcman K , Kostkiewicz M , Szot W , Lesniak-Sobelga A , Hlawaty M , Wisniowska-Smialek S , Dziewiecka E , Karabinowska A , Stepien A , Graczyk K , Mroz K , Podolec P , Rubis P 
Published: October 2021

Abstract

Background
Amyloid cardiomyopathy (CA) it is more frequently diagnosed due to rapidly developing imaging modalities. Misfolding of transthyretin (TTR) is the source of two distinct forms of amyloidosis (ATTR): acquired wild-type (ATTRwt) and hereditary (ATTRm). Types of TTR gene variants display genetic and ethnic variability. The aim of this prospective study was to assess the prevalence and types of pathogenic genetic variants associated with ATTRm amyloidosis in patients with unexplained left ventricle (LV) hypertrophy.

Methods
We evaluated prospectively 101 consecutive patients (37 (37%) females, age: 69.7±13.6 y.o.) in years 2016–2021. Analysis included clinical data, free light chain blood immunoglobulins and urine immunofixation, transthoracic echocardiography (TTE), single-photon emission computed tomography (SPECT) with 3,3-disphono-1,2-propanodicarboxylic acid (DPD), and in selected cases cardiac or soft tissue biopsy. Patients with DPD cardiac uptake in SPECT or positive histopathology or family history of ATTR were subjected to genetic testing by an amplicon-based next-generation TTR sequencing approach.

Results
Enrolled patients presented with marked LV hypertrophy with maximum wall thickness of 18.9±4 mm. Based on performed tests 34 patients (33.7%) were diagnosed with amyloidosis, including 17 cases of light-chain amyloidosis (AL), 16 of ATTR, and 1 case of other type of amyloidosis. Overall, patients with CA presented with mean 2.6±0.9 NYHA class. In TTE there was LV maximum wall thickness of 19.5±4 mm and LV mass value index value of 182±48 g/m2, decreased global longitudinal strain value (GLS, −14.1±5%) and advanced diastolic dysfunction (EA 2.2±1.1, E/E' 22±9). Overall, there were 8 cases of ATTRwt and eight patients were diagnosed ATTRm. There were detected following types of TTR variants - c.302C&gt;T p.(Ala101Val) in a single male patient, c.325G&gt;A p.(Glu109Lys) in a single male patient and c.157T&gt;C p.(Phe53Leu) in six patients. Overall, 10 patients with ATTR presented with polyneuropathy, additionally six had diagnosed carpal tunnel syndrome. All patients with ATTRm had positive family history for CA.

Conclusions
In patients with unexpected LV hypertrophy evaluated in a cardiology referral center a high number of patients may suffer from underlying CA. Types of detected TTR gene variants associated with CA included most often Phe53Leu, and rare variants Ala101Val, Glu109Lys.

Funding Acknowledgement
Type of funding sources: None.
Immediate & medium-term results of balloon dilatation in native coarctation of aorta: a reasonable initial management strategy
Authors: Singal A K , Ramakrishnan S , Kothari S S , Shivdas S , Gupta K , Gupta S K , Sharma S K , Saxena A 
Published: October 2021

Abstract

Background
Coarctation of aorta (CoA) accounts for 5–10% of all congenital heart defects. Despite &gt;20 years of experience with balloon dilatation (BD) as an effective therapy, initial choice of procedure still remains controversial.

Purpose
This study was planned to identify the predictors of success of BD in native CoA and to evaluate immediate & medium-term outcomes of the same.

Methods
This is a retrospective analysis of all BDs done over five years in a tertiary care centre. Success was defined as residual gradient ≤20 mmHg in the absence of a serious or life-threatening complication. In view of the high pre-dilatation gradient in many patients, a strict cut-off of 20 mmHg was not considered to be clinically feasible. Clinically acceptable outcome was thus defined as reduction of gradient to ≤20 mmHg or by ≥50% of baseline, to a final value ≤30 mmHg, in the absence of a serious or life-threatening complication. Repeat intervention on follow-up was considered in patients satisfying any of these criteria: symptoms attributed to CoA, significant residual gradient (&gt;20 mmHg) with diastolic spill on echo, LV dysfunction, or refractory hypertension.

Results
Of the 111 cases analysed, 85 (76.5%) were male. The mean age was 11.79±12.64 years (1 month to 57 years). Bicuspid aortic valve was the most common associated anomaly, present in 42 (38%) patients. The mean gradient fell from 53.15±22.37 mmHg to 14.83±12.24 mmHg. Overall, the procedure was successful in 83 (74.8%) patients, and clinically acceptable outcome was obtained in 97 (87.4%) patients. Success rate and clinically acceptable outcome rate in the &lt;18 years group was 80.7% (67/83) and 92.7% (77/83) respectively. Complications were seen in 9 (8.1%) cases. There was no mortality associated with the procedure. Ascending aortic pressure ≥150 mmHg [OR 27.94; 95% CI 1.30–598.84; p&lt;0.001], and balloon to isthmus ratio &lt;1 [OR 9.70; 95% CI 2.18–43.02; p&lt;0.001] were significant negative predictors for success. At median follow-up of 43.5 months, reintervention free survival rate was 79.5% (62/78) in the overall group, and 81.5% (53/65) in the &lt;18 years age group; with most of the repeat interventions being required within the first-year of the index procedure (14/16, 87.5%).

Conclusion
Immediate and medium-term success rates of BD in CoA are acceptable in majority of children and adolescents. High ascending aorta pressure and inadequate balloon size are important negative predictors of successful dilatation. Considering the economic advantages and reasonable success, balloon dilatation alone can be considered as a first line management option for native coarctation of aorta.

Funding Acknowledgement
Type of funding sources: None.
Heart failure hospitalization in adult patients with congenital heart disease: risk factors for repeated admissions
Authors: Scherrenberg H , De Meester P , Troost E , Santens B , Moons P , Budts W , Van De Bruaene A 
Published: October 2021

Abstract

Background
Heart failure hospitalizations in adult patients with congenital heart disease (ACHD) are increasing and are associated with higher healthcare-related costs. We aimed to evaluate factors that are associated with repeated heart failure hospitalizations and whether heart failure hospitalizations are related to adverse outcome in ACHD patients with heart failure (ACHD-HF).

Methods
Out of 3995 patients under active follow-up in our institution (last visit &gt;2010), 256 patients (mean age 49.5±16.7 years) had ACHD-HF and were included in the study. Medical records were reviewed, including heart failure hospitalization prior and after study inclusion. A combined endpoint of death, ventricular assist device and transplantation was defined.

Results
Overall, 136 ACHD-HF patients (53%) had a prior heart failure hospitalization. Over a mean follow-up of 2.5±2.3 years, 44 patients (17%) had repeated heart failure hospitalizations. Of these, 31 patients (12%) had 1; 9 patients (4%) 2 and 4 patients (2%) 3 repeated heart failure hospitalizations. Patients with repeated heart failure hospitalizations had higher NYHA class (p=0.031), were more likely to have end-organ dysfunction (p=0.025) and more likely to have a prior heart failure hospitalization (p&lt;0.001). In multivariable Cox regression analysis, only end-organ dysfunction (HR 2.431 95% CI 1.516–43.896 p&lt;0.001) was related to repeated hospitalization. Seventy patients (27%) reached the combined endpoint of death, VAD or transplantation (event-rate 11% per year). Repeated heart failure hospitalizations was not related to the combined endpoint in Cox regression analysis.

Conclusions
Heart failure hospitalizations are frequent in ACHD-HF. End-organ dysfunction appears to be a strong determinant of repeated heart failure hospitalizations. Event-rate is high in patients with ACHD-HF, but repeated heart failure hospitalizations were not related to outcome in this short-term follow-up study.

Funding Acknowledgement
Type of funding sources: None. Table 1.1Table 1.2