bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epicardial adipose tissue, cardiovascular hemodynamics and metabolic profile in heart failure with preserved and reduced ejection fraction
Authors: Pugliese N.R , Mazzola M , De Biase N , Paneni F , Del Punta L , Gargani L , Mengozzi A , Virdis A , Nesti L , Taddei S , Flammer A , Borlaug B.A , Ruschitzka F , Masi S 
Published: October 2021

Abstract

Background
Epicardial adipose tissue (EAT) acts as a paracrine organ and could exert direct mechanical compression on the myocardium.

Purpose
We investigated the impact of echocardiographic EAT thickness on metabolic profile and cardiovascular hemodynamics at rest and during exercise in heart failure (HF) patients with reduced (HFrEF) and preserved (HFpEF) ejection fraction

Methods
We prospectively enrolled 393 consecutive HF outpatients (205 HFrEF, 188 HFpEF) referred to the our hospital due to dyspnoea and/or effort intolerance. We performed a resting clinical and biohumoral evaluation, followed by combined cardiopulmonary-echocardiography exercise stress. The protocol also included 44 healthy controls.

Results
Patients with HFpEF displayed the greatest EAT thickness (median 8 mm, interquartile range [IQR] 4–12 mm), while those with HFrEF had thinner EAT (median 3 mm, IQR 2–6 mm) than controls (median 5 mm, IQR 3–7 mm; p&lt;0.0001). In HFrEF, EAT thickness was inversely associated with natriuretic peptides, Troponin T, and C-reactive protein levels. In HFpEF, it was directly correlated with Troponin-T and C-reactive protein levels. EAT thickness was inversely correlated with peak oxygen consumption (VO2) and peripheral oxygen extraction (AVO2diff) in HFpEF, while a direct association was observed in HFrEF (Fig 1). EAT resulted in an independent predictor of peak VO2 and AVO2diff in HFrEF and HFpEF regardless of body mass index, but the relationships were direct in HFrEF (standard regression coefficient [SRC] for peak VO2: 0.18, p=0.02; SRC for peak AVO2diff: 0.17, p=0.03) and indirect in HFpEF (SRC for peak VO2: −0.33, p&lt;0.0001; SRC for peak AVO2diff: −0.25, p&lt;0.0001).
The analysis of cardiac mechanics revealed that thinner EAT was associated with worse left ventricle systolic dysfunction (average S') and remodeling (3D left ventricle mass) in HFrEF. In HFpEF, increased EAT was related to more severe left atrio-ventricular (left atrium reservoir strain/left ventricle global longitudinal strain) and right ventriculo-arterial (tricuspid annular plane systolic excursion/systolic pulmonary artery pressure) coupling (Figure 2).

Conclusion
In HFpEF, EAT accumulation is associated with worse hemodynamic and metabolic profile. In HFrEF, conversely, EAT thinning portends more severe LV dysfunction and impaired global functional capacity.

Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
Differences in left ventricular twisting and different strains in patients with heart failure with preserved ejection fraction versus patients with arterial hypertension
Authors: Chilingaryan A , Tunyan L.G , Asatryan A.A , Tumasyan L.R , Kzhdryan H.K , Zelveyan P.H 
Published: October 2021

Abstract

Patients with advanced arterial hypertension (HPT) without heart failure often have left ventricular (LV) changes similar to hypertensive patients with heart failure with preserved ejection fraction (HFpEF). We assumed that cardiac mechanics may be different in both groups.

Methods
We study 58 patients (23 female) with HPT and with left ventricular concentric hypertrophy (LVH) as well as negative diastolic stress test and 52 HPT patients (29 female) with HFpEF NYHA II-III 72±5 years. All patients where in sinus rhythm. HPT and HFpEF patients has comparable degree of LV mass index (LVMI 85.3±8.6 g/m2 vs 86.2±8.9 g/m2, P=NS). Incidence of diabetes mellitus, chronic kidney disease or chronic obstructive lung disease was comparable between groups. 43 sex and age matched healthy subjects served as control (C). Comprehensive 2D/3D echocardiography (EchoCG) with offline measurements of longitudinal (LS), circumferential (CS) and radial strain (RS) global values of entire walls and 3 myocardial layers, LV twist (LVT)was performed before and after symptom limited or heart rate of 120 bpm limited diastolic stress test.

Results
HPT and HFpEF patients had significantly lower absolute values LS, CS, AS, as well as lower values of RS, and LVT compared with controls at rest and after stress test. The values of LS, RS and LVT did not significantly differ at rest in HPT patients and HFpEF patients, but HFpEF patients had lower values of global CS (GCS) due to reduction only in endocardial layer CS (ECS) (LS: 16.4±5.2% vs 16,8±5.9, p=0.07; ECS: 10.9±2,3% vs 17.3±4.1%, p&lt;0.01; GCS: 12.8±3.5% vs 15.1±2.1%, p&lt;0.03; RS: 29.7±10.2% vs 31.1±12.4%, p=0.06; LVT: 2.3±1.4deg vs 2.6±1.7deg, p=0.06). After diastolic stress test patients with HFpEF had significantly lower values of LVT and GCS compared with HPT patients (LVT: 1.8±0.9deg vs 3.4±1.8deg, p&lt;0.001; GCS: 10.4±2.7% vs 17.1±3.4%, p&lt;0.01). We also found greater relative increase (RI) in endocardial LS and LVT in patients with HPT after stress test compared with HFpEF patients, RI of other parameters did not differ between these two groups (RI ELS: 16±2.1% vs 10.5±1,7%, p&lt;0.03; RI LVT 33.3±6,4% vs −21.7±4.1%, p&lt;0.0001). ECS had the diagnostic value to predict HFpEF (area under curve 0.874), RI LVT was the best predictor of HFpEF symptoms (area under curve 0.912) with cut off value 22.3%.

Conclusion
ECS is reduced in HFpEF patients compared with HPT patients with the same degree of structural abnormalities on conventional EchoCG and is a predictor of HFpEF. HPT patients have more relative improvement in ELS during stress test compared with HFpEF patients. RI LVT was the best predictor of HFpEF symptoms.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): City Hall resources
Left atrial coupling index versus left atrial function index in heart failure with reduced ejection fraction and iron deficiency
Authors: Tsarouchas A , Bakogiannis C , Mouselimis D , Pagourelias E.D , Kelemanis I , Boulmpou A , Vergopoulos S , Vassilikou A , Tzikas S , Fragakis N , Papadopoulos C.E , Vassilikos V.P 
Published: October 2021

Abstract

Background
Left atrial (LA) form and function has been the focus of extensive research in heart failure with reduced ejection fraction (HFrEF). The LA coupling index (LACI, see Picture 1 for definition) and the LA function Index (LAFI) have both been proposed as potent predictors of morbidity and mortality in HFrEF. Albeit promising, both parameters have drawbacks that could limit their usefulness in clinical settings - LACI can only be measured during sinus rhythm (SR), while LAFI calculation is arguably more involved. A side-by-side comparison of the two indices has not yet been performed.

Purpose
Investigate and compare the feasibility and efficacy of using LACI and LAFI as prognostic factors in HFrEF.

Methods
HFrEF patients that visited our outpatient HF clinic were invited to participate in the study. Clinical examination, 6-minute walk testing, and a full echocardiographic study were performed, the latter enabling quantification of LACI, LAFI, as well as most traditional echocardiographic predictors of HF prognosis (Picture 1). LACI and LAFI cut-offs of 6 and 25 respectively were defined in accordance with the relevant literature. Cox regression was performed to assess each parameter's correlation with risk of HF-related hospitalization and mortality over a 6-month follow-up period.

Results
In the end, 63 patients were included in the study (aged 69.3±9.7 years, 84% male). LACI could not be measured in 19 patients due to atrial tachycardia. The median LACI was 6.2 (8.7) while the median LAFI of the entire sample was 24.8 (44.5). LACI and LAFI correlated strongly (r=−0.813, p&lt;0.001). Neither correlated significantly with the risk of HF-related hospitalization (Picture 1) or death in our sample (Picture 2). 6MWD was the only parameter to independently correlate with increased risk of hospitalization (HR=0.39, p&lt;0.001) or death (HR=0.42, p=0.02).

Conclusions
The collinearity detected between LACI and LAFI indicate that both quantify similar aspects of left atrial (dys)function. That said, neither index had significant capability to predict hospitalization or death in our sample of HFrEF patients. Although a non-significant trend for higher LACI in patients with poorer prognosis was detected in our sample, it was also incalculable in 30% of patients, who were not in SR during echocardiography. Extended follow-up of an expanded sample size will enable more refined investigation of LACI's and LAFI's prognostic capacity.

Funding Acknowledgement
Type of funding sources: None. Hospitalization Cox regression resultsLACI and LAFI survival curves
Outcomes of remote pulmonary artery hemodynamic monitoring in heart failure patients with obstructive sleep apnea
Authors: Oberoi M , Rajpurohit N , Petrasko M , Stys A , Stys T , Vicinsky D , Jonsson O 
Published: October 2021

Abstract

Introduction
Obstructive sleep apnea (OSA) is often associated with heart failure (HF). Remote pulmonary artery (PA) hemodynamic monitoring has shown to decrease HF related readmissions. However, there is paucity of data regarding its efficacy and mortality in patients with OSA.

Purpose
Real-world analysis of outcomes of remote PA hemodynamic monitoring using CardioMEMS device in reducing HF hospitalization in patients with OSA [apnea–hypopnea index (AHI) ≥5].

Methods
Retrospective data was collected for patients with HF who had CardioMEMS device implanted based on FDA indications from April 2015 to August 2020. The number of hospitalizations, emergency department (ED) and HF clinic visits data was collected for 1-year pre and 1-year post device implantation. Mortality data was also collected at 1-year post-implantation. Patients who were diagnosed with OSA based on AHI ≥5 on sleep study at the time of implantation were included in the study. Analysis was done using Kruskal-Wallis test for comparison between heart failure patients with and without OSA. Mortality was compared with Pearson's chi-squared test.

Results
CardioMEMS device was implanted in 177 patients during the study period. Of this population, 108 (61%) patients had known OSA at the time of implantation. There was a statistically significant decrease in overall mean HF admissions from 1.80 (± 1.55) to 0.62 (± 1.07), 65.6%, p&lt;0.001 and mean HF ED visits from 1.37 (± 1.50) to 0.5 (± 0.95), 63.5%, p&lt;0.001 in 1-year pre- and post-implantation among OSA patients. When comparing outcomes between HF patients with and without OSA, there was no statistically significant difference observed between them in all-cause admissions, HF admissions, ED visits, ED HF visits, and HF clinic visits 1-year pre and post implantation. Also, no statistically significant difference was observed in mortality between the groups at 1-year post-implantation.

Conclusions
PA hemodynamic monitoring using CardioMEMS device had a net benefit in reducing HF admissions and HF ED visits in OSA patients which was similar in patients without OSA.

Funding Acknowledgement
Type of funding sources: None.
Prognostic significance of anemia in women with suspected ischemia, an insight from the women ischemia syndrome evaluation study (WISE)
Authors: Asif A , Lauzon M , Sopko G , Bittner V , Reis S , Handberg E , Pepine C J , Mankad S , Bairey Merz N 
Published: October 2021

Abstract

Background
Anemia is associated with adverse cardiovascular outcomes in patients with myocardial infarction and congestive heart failure. Anemia is more prevalent in women. We investigated the prognosis of anemia in women with suspected ischemic heart disease.

Purpose
To study if hemoglobin levels at baseline in women with symptoms of ischemia predicts long term all-cause mortality and major adverse cardiac events.

Methods
We studied 885 women enrolled in WISE (1997–2001) undergoing clinically indicated coronary angiography for suspected ischemia. Anemia was defined as hemoglobin (Hb) level &lt;12g/dL. Major adverse cardiovascular event (MACE) included all-cause death, nonfatal myocardial infarction, stroke and heart failure hospitalization. Cox regression models and Kaplan-Meier methods were was used.

Results
Overall, 885 women, mean age 58.4±11.7 years, 21.1% and anemia were followed for 6.8 years. Anemic women had higher creatinine, history of diabetes mellitus, hypertension and CHF (p&lt;0.05), but not obstructive coronary artery disease compared to non-anemia women (p=0.97). Anemic women had higher all-cause mortality and MACE (Figure). In multivariate analysis, anemia was independently associated with increased MACE risk (hazard ratio (HR): 1.5, 95% confidence interval [1.11- 2.01, p=0.007]) but not all-cause mortality (HR: 1.2 [0.84–1.72, p=0.30]).

Conclusions
Among women evaluated for symptoms of ischemia, anemia is associated with and independently predicts MACE. Further research targeting anemia treatment in women to mitigate these adverse outcomes is warranted.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): NIH USA
Sex-dependent impact of coronary microvascular dysfunction on long-term clinical outcomes in patients with no-obstructive coronary artery disease
Authors: Toya T , Ahmad A , Corban M T , Sara J D , Ozcan I , Lerman L O , Lerman A 
Published: October 2021

Abstract

Background
Coronary vasomotor response is different between males and females. However, the prognostic impact of this difference in coronary physiologic indices has not been characterized in patients with no obstructive coronary artery disease (NOCAD).

Purpose
We aimed to investigate the sex-specific differences of coronary vasomotor function in response to adenosine in a large cohort of patients with NOCAD and its impact on long-term clinical outcomes

Methods
We included 668 NOCAD patients who underwent invasive coronary vasoreactivity testing using intracoronary incremental doses of adenosine (18–72 μg) with available follow-up data. Indices of coronary vasomotor response were compared between males and females, and their prognostic impact on major adverse cardiovascular events (MACE: death, myocardial infarction, revascularization, and stroke) were analyzed based on sex.

Results
Females (N=461, mean age 54±12 years) had lower baseline microvascular resistance (BMR) and higher baseline average peak velocity (APV) than males (N=207, mean age 53±13 years), while hyperemic microvascular resistance (HMR) and hyperemic APV were similar between males and females. Consequently, coronary flow reserve (CFR: hyperemic/baseline APV) and resistive reserve ratio (RRR: BMR/HMR) were lower in females than males (Figure 1A). Lower CFR and RRR, as well as lower BMR and higher baseline APV were associated with MACE only in males, but not in females. Higher HMR was the only predictor for MACE in females (Figure 1B).

Conclusions
Sex-specific differences in coronary vasomotor response to adenosine may provide different prognostic values between males and females.

Funding Acknowledgement
Type of funding sources: None.
Impact of previous cardiac conditions in prognosis and clinical management of patient with COVID-19 infection
Authors: Antonana S , Monteagudo J M , Arteagoitia A , Gonzalez A , Ortega R , Rivas S , Martinez-Moya R R , Sanroman M A , Lorente-Ros A , Rincon L M , Zamorano J L 
Published: October 2021

Abstract

Background
Recent studies suggest a higher mortality rate because of COVID-19 in patients with previous cardiac conditions compared to those without. Given the limited resources of intensive care units (ICU) during the pandemic outbreak, this fact has important implications.

Purpose
The main purpose of this study was to compare the 30-day mortality of the COVID-19 infection in patients with and without previous cardiac conditions. The secondary end point was to assess the differences in clinical severity of the infection (as development of Acute Respiratory Distress Syndrome – ARDS) and ICU admission amongst these patients.

Methods
A total of 1708 consecutive patients were prospectively included. The inclusion criteria were: a confirmed positive diagnosis of COVID-19 infection by PCR and being admitted to our centre between 18th and 23rd March 2020 and 22nd August and 9th January 2021. Patients were classified in two groups according to the presence of previous cardiac conditions (defined as previous history of myocardial infarction, heart failure and atrial fibrillation). Other comorbidities were extensively explored and Charlson Comorbidity Index was calculated. A propensity-score matching was performed and 145 patients with previous cardiac conditions were matched with 145 patients without.

Results
The group of patients with a previous cardiac condition included 421 patients (24.6%). The crude analysis showed a higher 30-day mortality rate among patients with previous cardiac affections (35.6% vs. 14.6%, p&lt;0.001). They were also less likely to be admitted to the ICU (9.8% vs. 6.2%, p=0.022) and had a higher prevalence ARDS (48.9% vs. 33.9%, p&lt;0.001). In the matched cohort, there were no significant differences between both groups regarding mortality (24.8% in the group of patients with previous cardiac conditions vs. 31.0%, p=0.272) nor ARDS prevalence (50.3% vs. 53.1%, p=0.655). There was a trend toward patients with previous cardiac conditions to be less likely to be admitted to the ICU (4.8% vs. 9.7%, p=0.090).

Conclusions
Patients with a personal history of previous cardiac conditions were less likely to be admitted to the ICU. However, our results show that when comparing cohorts with similar comorbidity burden, a previous cardiopathy “per se” does not significantly increase the risk of death in patients with a concomitant COVID infection.

Funding Acknowledgement
Type of funding sources: None. Mortality unmatched vs matched cohort
Comparison of in-hospital outcomes and 30-days readmissions between type 1 and type 2 myocardial infarction patients: a study of the nationwide readmissions database
Authors: Wu L , Song D D , Daibes J A , Das S , Pena M K , Tamis-Holland J 
Published: October 2021

Abstract

Introduction
Traditionally Type- 1 myocardial infarction (T1-MI) results from a plaque erosion, rupture, or fissure. In contrast, Type- 2 myocardial infarction (T2-MI) is a consequence of severe supply and demand mismatch. Despite the different mechanisms, both T1-MI and T2-MI can be associated with severe morbidity and mortality. Yet there is sparse data analyzing in-hospital outcomes and readmission rates comparing patients who present with T1-MI and T2-MI.

Purpose
We aimed to compare the outcome data of patients with T1-MI and T2-MI derived from the Nationwide Readmissions Database, a large national database of hospital readmissions.

Method
We utilized the 2018 Nationwide Readmissions Database to identify all index hospital admissions with a primary diagnosis of “acute MI” (AMI) using ICD-10 diagnosis codes. All AMI admissions were further categorized into ST-elevation myocardial infarction (STEMI), no-ST-elevation myocardial infarction (NSTEMI), or T2-MI. Primary outcomes analyzed included 30-days major adverse cardiovascular events (MACE) (defined as re-infarction, repeat revascularization and death within 30 days of admission), short term mortality and readmission rates.

Results
Among 556,816 total admissions for AMI, 28,250 (5.1%) were T2-MI. Table 1 compares baseline variables and short-term outcomes for patients with T1-MI vs T2-MI. Compared to patients with T1-MI patients with T2-MI were older, more likely to be female, and had a higher burden of comorbidities. Additionally, T2-MI patients were less likely to receive coronary revascularization during the index admission. The mean length of stay for T2-MI patients was 4.7±0.6 days, which is longer than the length of stay for STEMI patient (4.1±0.4 days) but slightly shorter than NSTEMI patient (4.9±0.4 days). T2-MI patients had a higher rate of all-cause 30-days readmissions but a lower rate of 30-days MACE. Early mortality rate (within 30 days of index admission) in T2-MI patients was comparable to NSTEMI patients but was lower than STEMI patients. Cox proportional-hazards model adjusting for age, sex, comorbidities and type of hospital setting demonstrated that T2-MI was associated with a lower 30-day MACE risk (T2-MI vs STEMI: [HR 0.33 (95% CI 0.31–0.36)]; T2-MI vs NSTEMI [HR 0.70 (95% CI 0.64–0.75)]) and a lower risk of early mortality (T2-MI vs STEMI: [HR 0.29 (95% CI 0.26–0.32)]; T2-MI vs NSTEMI [HR 0.71 (95% CI 0.65–0.79)]). The adjusted HR for 30-days all-cause readmissions was higher with T2-MI, (T2-MI vs STEMI: [HR 1.16 (95% CI 1.10–1.23)]; T2-MI vs NSTEMI: [HR 1.11 (95% CI 1.06–1.16)]).

Conclusion
T2-MI patients are older and have a higher burden of comorbidities. After adjusting for baseline comorbidities, all-cause readmission risk is higher in T2-MI but short-term MACE and mortality is lower with T2-MI.

Funding Acknowledgement
Type of funding sources: None.
Machine learning aids clinical decision making in patients presenting with angina and non-obstructive coronary artery disease
Authors: Ahmad A , Shelly Cohen M , Corban M T , Murphree Jr D H , Toya T , Sara J D , Ozcan I , Lerman L O , Friedman P A , Attia Z I , Lerman A 
Published: October 2021

Abstract

Background
Coronary microvascular dysfunction (CMD) is associated with an increased risk of cardiovascular morbidity and mortality. The current gold-standard comprehensive assessment of CMD is through a limited-access invasive catheterization lab procedure.

Purposes
We aimed to develop a point-of-care tool to assist clinical guidance in patients presenting with chest pain and/or an abnormal functional stress test and with non-obstructive coronary artery disease (NOCAD) based on demographic data and resting ECG waveforms.

Methods
This study included 1,893 NOCAD patients (&lt;50% angiographic stenosis) who underwent CMD evaluation as well as a standard ECG up to 1 year prior. Microvascular endothelial-independent dysfunction was defined by abnormal coronary flow reserve (CFR) &lt;2.5 in response to intracoronary adenosine administration. Microvascular endothelial dysfunction was defined by a maximal percent increase in coronary blood flow (%ΔCBF) ≤50% in response to intracoronary acetylcholine infusion. We trained algorithms to distinguish between the following outcomes: CFR ≤2.5, ΔCBF (%) ≤50, and the combination of both. Two classes of algorithms were trained, one depending on ECG waveforms as input, and another using tabular style clinical data. The optimal classification threshold was determined by maximizing Youden's J.

Results
Mean age was 51±12 years and 66% were females (n=1,257). AUC values ranged from 0.49 to 0.67 for all the outcomes. The best performance in our analysis was for the outcome CFR ≤2.5 via logistic regression on tabular variables. AUC and accuracy were 0.67 and 60%; while sensitivity and NPV were 70% and 85%. Specificity and PPV were 56% and 0.35%. When decreasing the threshold from the “optimal” one (24%) to 15%, sensitivity and NPV increased to 92% and 90% respectively, while specificity and PPV decreased to 25% and 29% respectively (Figure 2).

Conclusion
An AI-enabled algorithm may be able to assist clinical guidance by ruling out CMD in patients presenting with chest pain and/or an abnormal functional stress test. This algorithm needs to be prospectively validated in different cohorts.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The James Nutter Family & Maria Long Family Fellowship in Cardiovascular Research and Mayo Clinic Figure 1Figure 2