bluuebunny/crossref_metadata_2025_split huggingface dataset:
62 Biventricular evaluation of gliflozines effects in chronic heart failure patients function (begin-HF study): an international registry
Authors: Correale Michele , Mazzeo Pietro , Petroni Renata , Coiro Stefano , Antohi Elena-Laura , Monitillo Francesco , Leone Marta , Triggiani Marco , Dungen Hans-Dirk , Sarwar Chaudhry M. S. , Nodari Savina 
Published: December 2021

Abstract

Aims
Sodium glucose cotransporter type 2 (SGLT2) inhibitors represent a new class of hypoglycemic agents for type 2 diabetes mellitus (T2DM), which act independently of insulin to selectively inhibit renal glucose reabsorption, thereby increasing urinary excretion of glucose. Several studies have demonstrated the cardioprotective effects of SGLT2-i in patients with heart failure (HF), with and without diabetes mellitus. It is also unknown whether these SGLT2is-associated benefits are associated with the amelioration of left or right ventricular function in patients affected by HF with T2DM. Evaluate the effect of SGLT2 inhibitors on left and right ventricular function by conventional and advanced echocardiographic parameters, focusing on speckle tracking echocardiography, in patients with HF and T2DM.

Methods and results
BEGIN-HF is an international multi-centre registry enrolling outpatients affected by HF and T2DM. Inclusion criteria are HbA1c&gt; 6.5%, eGFR [MDRD] &gt; 45 ml/min/1.73 m2, age &gt; 18 years, FE &lt; 50%. Exclusion criteria are type 1 diabetes mellitus (T1DM), previous amputation surgery, recurrent urinary tract infections. For each patient medical history, clinical and biochemistry data will be collected, starting treatment with SGLT2 inhibitors will be included. All patients will undergo conventional, TDI, and strain echocardiography in an ambulatory setting, at the enrollement and after 3 and 6 months. The patients will be divided in the two subgroup for analysis (patients starting SGLT2i therapy and patients no starting SGLT2i). The primary endpoint will be the improvement of LV systolic and right ventricular systolic function as assessed by conventional, TDI and myocardial deformation speckle tracking parameters. A univariate and multivariate analysis will be performed to search for predictors of improvement of systolic function.

Conclusions
This is the first international multicentre registry evaluating biventricular function by conventional and advanced echocardiography in patients with HF and T2DM starting and no-starting SGLT2i therapy.
155 Effects on sacubitril/valsartan on natriuretic peptides in patients with a reduced ejection fraction
Authors: Lamaida Norman , Cerciello Antonio 
Published: December 2021

Abstract

Aims
The PARADIGM-HF trial proved the superiority of sacubitril/valsartan (Sa/Va) vs. enalapril in reducing mortality and hospitalization for heart failure (HF). Sacubitril/valsartan, new drug used in treatment of heart failure with reduced systolic function (HFrEF) has recently been shown to improve tolerance to exercise and cardiovascular performance.

Methods and results
We prospectively enrolled 40 outpatient patients with HFrEF with indication for therapy with sacubitril/valsartan and subjected to serial controls with blood tests, echocardiogram before and during gradual optimization of therapy, with the aim of evaluating the effects of the drug on left ventricular remodelling. We studied 40 patients treated with sacubitril/valsartan for at least 3 months. After a mean follow-up of 120 ± 40 days, 95% of patients reached the maximum dose of the drug without major side effects. The ejection fraction increased while end-diastolic and end-systolic volumes of the left ventricle decreased. We also observed a significant reduction in NT-proBNP values without significant worsening of renal function or hyperkalaemia. There NYHA functional class has improved with a positive impact on the prognosis of heart failure at 2 years (P = 0.006).

Conclusions
In our population, medium-term treatment with sacubitril/valsartan demonstrated a favourable effect on left ventricular remodelling and functional status, confirming the data of previous clinical trials in real life. One more follow-up long and a larger population will help confirm these to confirm these positive effects of the drug on patients with HfrEF.
359 Transient vs. persistent improved ejection fraction in non-ischaemic dilated cardiomyopathy
Authors: Manca Paolo , Stolfo Davide , Merlo Marco , Gregorio Caterina , Cannatà Antonio , Ramani Federica , Nuzzi Vincenzo , Lund Lars , Savarese Gianluigi , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
The recent definition of heart failure with improved ejection fraction (HFimpEF) outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and the correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF).

Methods and results
Consecutive NICM patients with baseline LVEF ≤40% enrolled in the Trieste Heart Muscle Disease Registry with ≥1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF ≤40%, a ≥ 10 point increase from baseline LVEF, and a second measurement of LVEF &gt;40%. Transient impEF was defined by the documentation of recurrent LVEF ≤40% during follow-up. The primary endpoint was a composite of all-cause death, heart transplantation and left ventricular assist device (D/HT/LVAD). Among 800 patients, 460 (57%) had impEF (median time to improvement 13 months). Higher heart rate, smaller left atrium, absence of severe mitral regurgitation and shorter duration of disease were associated with impEF. ImpEF was independently associated with lower risk of D/HT/LVAD (HR: 0.36; 95% CI: 0.27–0.48; P &lt; 0.001). Transient impEF was observed in 189 patients (41% of the overall impEF group) and was associated with higher risk of D/HT/LVAD compared with persistent impEF at multivariable analysis (HR: 2.54; 95% CI: 1.60–4.04).

Conclusions
In NICM, we observed a 57% rate of impEF. However, recurrent decline in LVEF was observed in ≈40% of impEF patients and it was associated with an increased risk of D/HT/LVAD.
362 Trends in the use/non-use of guideline-directed medical therapy in non-ischaemic dilated cardiomyopathy with improved ejection fraction
Authors: Santi Giovanni , Manca Paolo , Nuzzi Vincenzo , Venturelli Francesco , Ramani Federica , Barbati Giulia , Gregorio Caterina , Stolfo Davide , Merlo Marco , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Guideline-directed medical therapy (GDMT) is associated with significant improvement of left ventricular function in an important fraction of patients with non-ischaemic dilated cardiomyopathy (NICM), and the recent definition of heart failure with improved ejection fraction (HFimpEF) highlights the importance of longitudinal assessment of left ventricular ejection fraction (LVEF); however, little is known about the long-term outcome of GDMT downtitration in patients with NICM who develop HFimpEF. We sought to assess the functional and prognostic impact of GDMT downtitration in this subgroup.

Methods and results
All consecutive NICM patients enrolled from 1991 to 2018 in the Trieste Heart Muscle Disease Registry with baseline LVEF ≤40% and with ≥1 LVEF assessment after baseline were included. ImpEF was defined as a baseline LVEF ≤40%, a ≥ 10 point increase from baseline LVEF, and a second measurement of LVEF &gt;40%. GDMT downtitration was defined as any dose reduction or drug withdrawal of renin-angiotensin system inhibitors (RASi) or beta-blockers (BB). The outcome measures were a loss of impEF criteria, a composite of all-cause death and heart transplantation (ACD/HTx), a composite of HF hospitalization, heart transplantation and left ventricular assist device (HFH/HTx/LVAD), and a composite of sudden death and major ventricular arrhythmias (SD/MVA). The prognostic role of GDMT downtitration was assessed with Kaplan–Meier analysis and curves of cumulative incidence, considering GDMT downtitration, loss of impEF, and the composites of outcome as time-dependent variables. Among 452 NICM patients with impEF, 186 (41.2%) downtitrated GDMT (median time to downtitration 35 months). Loss of impEF criteria occurred in 186 patients (median time to loss of impEF 51 months). While no significant differences in terms of ACD/HTx, HFH/HTx/LVAD, or SD/MVA among those who downtitrated GDMT and those who didn’t were observed, the population that downtitrated GDMT had a higher cumulative incidence of loss of impEF (P &lt; 0.001).

Conclusions
In NICM patients who develop impEF, we observed a ≈ 40% rate of recurrent decline of LVEF. GDMT downtitration seems to be associated with this functional deterioration, although no differences in terms of major cardiovascular outcomes emerged.
379 Contemporary use of guideline directed medical therapy in dilated cardiomyopathy: therapeutic optimization and prognostic benefits
Authors: Venturelli Francesco , Nuzzi Vincenzo , Manca Paolo , Santi Giovanni , Barbati Giulia , Gregorio Caterina , Stolfo Davide , Merlo Marco , Sinagra Gianfranco 
Published: December 2021

Abstract

Aims
Therapy with antineurohormonal drugs at target doses has a prognostic benefits in heart failure with reduced ejection fraction. Dilated cardiomyopathy (DCM) represents a particular setting where the possible benefit of target doses of antineurohormonal drugs is unexplored.

Methods and results
All patients enrolled from 1/1/1992 to 1/3/2020 in the Trieste Muscle Heart Disease register affected by DCM with data on the dosage of therapy available both enrollment and at follow-up visit (i.e., 6–12 month) were included. The population was divided according to the percentage of recommended dose prescribed (0–49%, 50–99%, 100%) of both renin-angiotensin system inhibitors (RASi) and beta blockers (BB). A composite of death/heart transplant/hospitalization for heart failure was considered as the primary endpoint; a composite of sudden cardiac death/major ventricular arrythmias/defibrillator intervention was evaluated as a secondary endpoint. Prognostic associations were explored with uni- and multivariate analyses, Cox regressions, Kaplan–Meier, cumulative incidence curves and propensity score matching. 826 patients were included. At baseline 789 (96%) were taking a RASi and 627 (76%) a BB. The target dose of RASi was prescribed in 29% and 36% of patients at enrolment and at follow-up visit, respectively. The percentage of patients taking the maximum recommended dose of BB was 10% at baseline and 17% after optimization. Predictors of reaching target dose for RASi were BMI &lt; 25 kg/m2, male sex [HR: 1.798 (95% CI: 1.073–3.012), P = 0.026] and higher systolic blood pressure [HR per mmHg 1.038 (95% CI: 1.025–1.051), P &lt; 0.001]. Target dose predictors of BB were age [HR per year 0.527 (95% CI: 0.347–0.802), P = 0.003] and highest systolic blood pressure [HR per mmHg 1.024 (95% CI: 1.013–1.035), P &lt; 0.001]. After adjustment target dose of RASi or BB did not show a significant association with the risk of primary outcome occurrence compared to those taking less than 50% (P = 0.550 for RASi and P = 0.921 for BB). The incidence of arrhythmic events was significantly lower in patients taking 100% of recommended dose of BB compared to those taking less than 50% (P = 0.009), after adjustment for confounders. The target dose of RASi was not associated with an arrhythmic events risk change (P = 0.688).

Conclusions
In DCM a significant number of patients do not tolerate maximal therapy doses, mainly due to hypotension. The achievement of the target dose of RASi and BB, after adjustment for confounders had a neutral effect on the incidence of heart failure-related events. Uptitration of BB to the recommended dose has a strong protective effect on arrhythmic events.
520 A possible easy way to predict response to cardiac resynchronization therapy: the role of QRS index
Authors: Coppola Giuseppe , Novo Giuseppina , Prezioso Amedeo , Bonnì Enrico , Madaudo Cristina , Campo Francesco , Sucato Vincenzo , Ciaramitaro Gianfranco , Galassi Alfredo Ruggero , Corrado Egle 
Published: December 2021

Abstract
Several studies have evaluated the role of QRS duration or QRS narrowing as predictor of response to cardiac resynchronization therapy (CRT) in order to reduce non-responders. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who underwent CRT implantation. We included 115 patients in whom a CRT device was implanted in accordance with current guidelines. Baseline clinical variables, echocardiographic parameters, and pharmacological therapies were included. QRS duration before and after CRT implantation and QI [(pre implant QRS duration—QRS duration during CRT)/pre implant QRS duration × 100] were measured. After 6 months, a significant improvement in all echocardiographic parameters was observed. In 103 (90%) patients, LVESV decreased by 10% or more. QI was significantly related to reverse remodelling (r = +0.19; 95% CI: 0.006–0.35, P = 0.049). The cut-off value of QI that predicted best LV reverse remodelling after 6 months of CRT was 12.25% (sensitivity = 65.5%, specificity = 75%, area under the curve = 0.737, P = 0.001). An improvement in their HF clinical composite score at 12 months was found in 23 patients (21%). Considering the improvement in NYHA class, of the 73 patients with QI &gt; 12.25%, 34 (46.5%) had a reduced NYHA class at 12 months post implantation. A statistically significant difference was found between patients with a QI &lt; 12.25%, and those with a QI &gt; 12.25%, in terms of NYHA class worsening (P 0.04). Also a statistically significant difference was found between the mean of the QI of patients who died from cardiovascular causes and patients who died of other causes. We have also investigated the possible sex differences related to QI; women with QI &gt; 12.25% had a statistically significant greater improvement in LVEF at follow-up than men with QI &gt; 12.25% (P 0.03). Patients with a larger decrease in QRSd after CRT initiation showed greater echocardiographic reverse remodelling and better outcome from death or cardiovascular hospitalization. Even if larger studies are needed, QI seems to be an easy-to-measure variable that could be used or evaluated to predict CRT response.
569 Advanced heart failure patients: insight clinical characteristics and prognosis
Authors: Ruocco Gaetano , Pastorini Guido , Rossi Arianna , Testa Marzia , Feola Mauro 
Published: December 2021

Abstract

Aims
The prevalence of patients with advanced heart failure (HF) ranges from 1% to 10% of HF population. A recent position statement of Heart Failure Association (HFA) of European Society of Cardiology (ESC), defined advanced HF according four criteria including LV dysfunction, symptoms severity, and HF hospital admission.1 In this study we would like to evaluate clinical and prognostic characteristics of HF patients in advanced stage.

Methods and results
This is an observational retrospective study enrolling patients with diagnosis of acute heart failure (AHF) de novo or not, admitted to our department from January 2015 to January 2019 within 12 h from emergency department admission. Patients underwent to clinical examination, laboratory analysis (NTproBNP, renal function haemoglobin) and echocardiography. Advanced heart failure patients were defined on the basis of ESC recent criteria.1 Patients were followed for 1 year after hospital discharge for the composite outcome of HF re-hospitalization and cardiovascular death through 1 year. A total of 601 AHF patients were included in this analysis. Median age was 78 (70–83) years, median of left ventricular ejection fraction (LVEF) was 45 (33–55)% and the median of serum levels of NTproBNP was 7851 (3222–17 543) pg/ml. In our sample we found 122 patients who met the criteria of advanced HF. Comparing patients with advanced HF and without we found that advanced HF patients were more frequent affected by not ischaemic cardiomyopathy with respect to patients not advanced (85% vs. 49%; P &lt; 0.001). Moreover, patients not advanced were more frequent de novo HF with respect to advanced ones (54% vs. 34%; P &lt; 0.001). Advanced heart failure patients showed higher values of NTproBNP [12 375 (5346–26 375) vs. 6652 (2552–13 782) pg/ml; P &lt; 0.001] and creatinine [1.20 (0.88–1.99) vs. 1.07 (0.82–1.50) mg/dL; P = 0.002] and lower values of TAPSE [18 (15–20) vs. 16 (13–19) mm; P &lt; 0.001], eGFR [48 (30–66) vs. 52 (38–38) ml/min/m2; P = 0.05], and serum sodium [140 (138–143) vs. 139 (136–141) mEq/l; P = 0.001] with respect to not advanced HF patients. Univariate analysis showed that advanced HF was related to poor prognosis in terms of one year cardiovascular death or HF re-hospitalization [HR: 1.83 (1.32–2.54); P &lt; 0.001] and in terms of in-hospital mortality [HR: 2.53 (1.01–6.53); P = 0.05].

Conclusions
Advanced HF patients showed a worse neuro-hormonal and renal pattern compared to not advanced ones. Similarly, these patients experienced a worse right ventricular function and were more prone no adverse events development at 1 year. Further study are mandatory to better manage these patients improving their outcome.
573 Different renal function patterns in acute heart failure patients
Authors: Ruocco Gaetano , Feola Mauro , Luschi Lorenzo , Brazzi Angelica , Ghionzoli Nicolo , Rossi Arianna , Pagliaro Antonio , Crescenzi Federico , Palazzuoli Alberto 
Published: December 2021

Abstract

Aims
The role of worsening renal function during acute heart failure (AHF) hospitalization is still debated. Very few studies have extensively evaluated the renal function (RF) trend during hospitalization by repetitive measurements. The aim of this study is to investigate the prognostic relevance of different RF trajectories together with the congestion status in hospitalized patients.

Methods and results
This is a post hoc analysis of a multi-centres study including 467 patients admitted with AHF who were screened for the Diur-AHF Trial. We recognized five main RF trajectories based on serum creatinine and estimated glomerular filtration rate (eGFR) behaviour: according to the RF curve our sample was divided into 1-stable (S), 2-transient improvement (TI), 3-permanent improvement (PI), 4-transient worsening (TW), and 5-persistent worsening (PW). The primary outcome was the combined endpoint of 180 days including all causes of mortality and re-hospitalization.
We recruited 467 subjects with a mean congestion score of 3.5 ± 1.08 and a median creatinine value of 1.28 (1.00–1.70) mg/dl, eGFR 50 (37–65) ml/min/m2, and NTpro BNP 7000 (4200–11 700) pg/ml. A univariate analysis of the RF pattern demonstrated that TI and PW patterns were significantly related to poor prognosis [HR: 2.71 (1.81–4.05); P &lt; 0.001; HR: 1.68 (1.15–2.45); P = 0.007, respectively]. Conversely, the TW pattern showed a significantly protective effect on outcome [HR: 0.34 (0.19–0.60); P &lt; 0.001]. Persistence of congestion and BNP reduction ≥ 30% were significantly related to clinical outcome at univariate analysis [HR: 2.41 (1.81–3.21); P &lt; 0.001 and HR: 0.47 (0.35–0.67); P &lt; 0.001]. A multivariable analysis confirmed the independently prognostic role of TI, PW patterns, persistence of congestion, and reduced BNP decrease at discharge.

Conclusions
Various RF patterns during AHF hospitalization are associated with different risk(s). PW and TI appear to be the two trajectories related to worse outcome. Current findings confirm the importance of RF evaluation during and after hospitalization.
632 Diagnostic and prognostic performance of HFA-PEFF and H2FpEF scores in patients with cardiac amyloidosis
Authors: Tomasoni Daniela , Merlo Marco , Aimo Alberto , Porcari Aldostefano , Angelis Maria Grazia De , Longo Francesca , Rossi Maddalena , Nardi Matilde , Vergaro Giuseppe , Lombardi Carlo Mario , Emdin Michele , Sinagra Gianfranco , Metra Marco 
Published: December 2021

Abstract

Aims
HFA-PEFF and H2FPEF scores were developed to aid the diagnosis of heart failure with preserved ejection fraction (HFpEF) and have been associated with outcomes. We aimed to investigate the diagnostic and prognostic significance of these scores in patients with a specific phenotype of HFpEF, cardiac amyloidosis (CA).

Methods and results
In a retrospective, double-centre, observational study we included 171 patients with either transthyretin (ATTR) (n = 89, 52%) or light-chain (AL) (n = 82, 48%) cardiac amyloidosis and preserved left ventricular ejection fraction (LVEF). Patients were divided into three groups according to HFA-PEFF score (low, 0–1; intermediate 2–4; high 5–6) and H2FPEF score (low, 0–1; intermediate 2–5; high 6–9). None of the patients had a HFA-PEFF score of 0 or 1 (n = 0, 0%); 57 (33.3%) patients had HFA-PEFF score 2–4 and the majority (n = 114, 66.7%) had a high HFA-PEFF score. Twenty-eight (16.4%), 104 (60.8%), 39 (22.8%) patients had low, intermediate, and high H2FPEF score, respectively. During a median follow-up of 14.5 (6.5–30.2) months after diagnosis, 61 (35.7%) patients died. Patients with a high HFA-PEFF score had higher mortality, compared to those with an intermediate score (47.4% vs. 12.3%, P &lt; 0.001). After adjustment for several clinical variables, including age, sex, comorbidities, natriuretic peptides, troponin levels and echocardiographic parameters, a high HFA-PEFF score was independently associated with mortality (HR: 3.75; 95% CI: 1.61–8.70; P = 0.005). H2FPEF score was not significantly associated with outcomes.

Conclusions
Our results suggest that a low HFA-PEFF score successfully rules out CA diagnosis, whereas some CA patients present a low H2FPEF score, potentially misleading the diagnosis. HFA-PEFF but not H2FPEF score was associated with outcome in patients with CA.