bluuebunny/crossref_metadata_2025_split huggingface dataset:
The relationship of dehydration and body mass index with the occurrence of atrial fibrillation in heart failure patients
Authors: Chuda A , Kaszkowiak M , Banach M , Maciejewski M , Bielecka-Dabrowa A 
Published: October 2021

Abstract

Background/Introduction
Heart failure (HF) and atrial fibrillation (AF) are two conditions that are likely to dominate the next years of cardiovascular (CV) care. These diseases frequently coexist and they can beget one another due to similar risk factors and similar pathophysiology.

Purpose
The aim of the study was to assess the relationship of dehydration, body mass index (BMI) and other indices with the occurrence of AF in HF patients.

Methods
The study included 113 patients [median age 64 years; 57.52% male] hospitalized due to HF. Baseline demographics, body mass analysis, echocardiographic results, key cardiopulmonary exercise test (CPET) parameters, six minute walk distance (6MWD) and Kansas City Cardiomyopathy Questionnaire (KCCQ) score were assessed.

Results
Of all patients, 23 (20.35%) had AF, and 90 (79.65%) had sinus rhythm (SR). Patients with AF were older (med. 66 vs 64 years; p=0.039), with higher BMI (32.02 vs. 28.51 kg/m2; p=0.017) and percentage of fat content (37.0 vs. 27.9%, p=0.014). They were more dehydrated, with a lower percentage of total body water (TBW%) (45.7 vs 50.0%; p=0.022). Clinically, patients with AF had more often higher New York Heart Association (NYHA) class (III vs II; p&lt;0.001), shorter 6MWD (median 292.35 vs 378.4 m; p=0.001) and a lower KCCQ overall summary score (52.60 vs 73.96 points; p=0.002). Patients with AF had significantly lower exercise capacity as measured by peak oxygen consumption (peak VO2) (0.92 vs 1.26 mL/min, p=0.016), peak VO2/kg (11 vs. 15 mL/kg/min; p&lt;0.001), and percentage of predicted VO2max (pp-peak VO2) (62.5 vs 70.0; p=0.010). We also found VE/VCO2 (med.33.85 vs 32.20; p=0.049) to be higher and peak oxygen pulse (8.5 vs 11 mL/beat; p=0.038) to be lower in patients with AF than in patients without AF. In a multiple logistic regression model higher BMI (OR 1.23 per unit increase, p&lt;0.001) and higher left atrial volume index (LAVI) (OR 1.07 per unit increase, p=0.03), lower tricuspid annular plane systolic excursion (TAPSE) (OR 0.74 per unit increase, p=0.03) and lower TBW% in body mass analysis (OR 0.90 per unit increase, p=0.03) were independently related to AF in patients with HF.

Conclusions
Increased volume of left atrium and right ventricular systolic dysfunction are well-known predictors of AF occurrence in patients with HF, but hydration status and increased body mass also seem to be important factors of AF in HF patients.

Funding Acknowledgement
Type of funding sources: None. Figure 1
Impact of idiopathic pulmonary fibrosis on the clinical outcomes of patients admitted for acute decompensated heart failure: an analysis of U.S national inpatient sample
Authors: Almani M , Usman M , Qudrat Ullah M , Yousuf M , Fatima N 
Published: October 2021

Abstract

Background
The cardiovascular manifestations of idiopathic pulmonary fibrosis (IPF) include heart failure, pulmonary hypertension, coronary artery disease, cardiac arrhythmias and cardiac manifestations of drugs used to treat IPF. Cardiac disease can be worsened by hypoxia and pulmonary hypertension by IPF. The impact of IPF on the outcomes of acute decompensated heart failure (ADHF) is not well studied.

Purpose
We aim to determine the outcomes of patients admitted for ADHF with co-morbid IPF.

Methods
Data were extracted from the National Inpatient Sample (NIS) 2016 - 2018 Database. The NIS was searched for hospitalizations for adult patients with ADHF as principal discharge diagnosis with and without IPF as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are detailed in table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. A univariate screen was done to further confirm that these factors affected outcomes with variables having a p-value less than 0.2 included in the multivariate regression analysis. STATA software was used to for analysis.

Results
Of 1,007,824 patients admitted for ADHF, 1850 (0.2%) had IPF. Patients with IPF were significantly younger at the time of hospitalization for ADHF (71 years vs. 76 years, p&lt;0.001). There were 46% females in IPF group compared to 48% in the non-IPF group, p=0.451. The adjusted odds ratio (aOR) for inpatient mortality for ADHF with IPF compared to those without IPF was 2.82 (95% CI 1.897–4.215, p&lt;0.001). Patients with comorbid IPF had 1 day increase in mean length of stay (95% CI 0.475–1.525, p&lt;0.001). Detailed outcomes are listed in table 1.

Conclusions
Co-morbid IPF leads to higher inpatient mortality and higher length of hospitalization in patients with acute decompensated heart failure. It is prudent to risk stratify these patients to improve overall morbidity and mortality.

Funding Acknowledgement
Type of funding sources: None.
Acute heart failure in women: phenotypes and outcomes in Mexico. Gender differences?
Authors: Alvarez-San Gabriel A , Gonzalez-Pacheco H , Arias-Mendoza A , Guizar-Sanchez C , Manzur-Sandoval D , Araiza-Garaygordobil D , Jordan-Rios A , Gopar-Nieto R , Sierra-Lara Martinez D , Mendez-Ortiz A , Briseno-De La Cruz J L , Favela-Garcia K , Sanchez A , Ramirez-Rangel P 
Published: October 2021

Abstract

Background
Latin America has limited information about sex differences in acute heart failure and about hospital outcome. This study sought to examine clinical features and outcomes of patients with AHF in a coronary care unit of a single Mexican institution.

Aims
To examine the sex differences in clinical features, phenotype, etiologies and mortality of patients with acute heart failure in a single institution of Latin-America.

Methods
This was a retrospective study of consecutive patients hospitalized with AHF in a coronary care unit of a Mexican teaching hospital between January 2006 and December 2020.

Results
During the study period, 24,262 patients were hospitalized, 9,408 (38.8%) had AHF, of which 3,230 (34.3%) were women. Women with AHF, compared to men with AHF, were older (median, 64 vs. 61 years, P&lt;0.0001) and more likely to have a history of hypertension, stroke, atrial fibrillation, and hypothyroidism. The ischemic heart disease was more frequent in men (67.8% vs 40.5%; p&lt;0.0001), however, valvular heart disease and cardiomyopathies were more frequent in women (32.9% vs 16.9% and 16.0 vs 10.2%, respectively; p&lt;0.0001) (figure 1).
At presentation, women had a higher frequency of worsening chronic HF (59.8%), worse NYHA class, preserved left ventricular ejection fraction (LVEF) (median, 45% vs 38%; P&lt;0.0001), and lower estimated glomerular filtration rates.
Overall, unadjusted in-hospital mortality was higher in women (18.9 vs 16.1, p&lt;0.0001), but only different in ischemic heart disease (18.2 vs 15.7, p&lt;0.03) and valvular heart disease (21.8 vs 18.2%, p&lt;0.03). In-hospital mortality adjusted for age and LVEF showed that women had a higher risk of death. (Odds ratio 1.34; 95% CI, 1.19–1.51, P&lt;0.0001) (figure 2).

Conclusions
In this cohort of Mexican patients hospitalized with AHF, there were important differences in clinical characteristics and aetiologies between women and men. Women have a higher frequency of worsening chronic HF and as well as renal function. Nevertheless, despite having a preserved LVEF, in-hospital mortality was higher in women compared to men.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Aetiology in acute heart failureFigure 2. Kaplan-Meier curves for mortality
Right heart dysfunction and readmission risk across left ventricular ejection fraction status in patients with acute heart failure
Authors: Santas Olmeda E , Minana G , Palau P , De La Espriella R , Lorenzo M , Nunez G , Heredia R , Chorro F J , Nunez J 
Published: October 2021

Abstract

Background
Right heart dysfunction (RHD) parameters, such as right ventricular to pulmonary artery uncoupling or significant tricuspid regurgitation (TR) are increasingly important in heart failure (HF), especially in patients with preserved ejection fraction. In this study, we aimed to evaluate the association of advanced RHD with the risk of recurrent admissions across the spectrum of left ventricular ejection fraction (LVEF).

Methods
We included 3,383 consecutive patients discharged for acute HF (AHF). Of them, in 1,435 (42.4%) pulmonary artery systolic pressure (PASP) could not be accurately measured, leaving a final sample size of 1,948 patients. Advanced RHD was defined as the combination of a ratio of tricuspid annular plane systolic excursion (TAPSE)/PASP&lt;0.36 and a significant functional TR (n=196, 10.2%). Negative binomial regression analyses were used to evaluate the risk of recurrent admissions.

Results
At a median follow up of 2.2 years (IQR=0.63–4.71), 3,782 readmissions were registered in 1,296 patients (66.5%). Patients with advanced RHD showed higher rates of readmissions, but only if LVEF≥40% (p&lt;0.001). In multivariable analyses, this differential association persisted for CV and HF recurrent admissions (p-value for interaction=0.016 and p=0.020; respectively). Advanced RHD was independently associated with the risk of recurrent CV and HF admissions if HF with LVEF≥40% (IRR: 1.99, 95% CI: 1.47–2.69, p&lt;0.001; and IRR: 2.02, 95% CI: 1.45–2.81, p&lt;0.001; respectively). In contrast, it was not associated with readmission risks if LVEF&lt;40%.

Conclusion
Following an admission for AHF, advanced RHD was strongly associated with a higher risk of recurrent CV and HF admissions, but only in patients with LVEF≥40%.

Funding Acknowledgement
Type of funding sources: None.
Impact of cardiac amyloidosis on outcomes of patients hospitalized with heart failure in Germany
Authors: Goebel S , Hobohm L , Desuki A , Gori T , Muenzel T , Rapezzi C , Wenzel P , Keller K 
Published: October 2021

Abstract

Background
Amyloidosis is a multi-systemic disease resulting from deposition of misfolded proteins as insoluble fibrils in the interstitium of affected organs including the heart, subsequently leading to organ failure. Cardiac involvement is predominantly observed in light chain (AL) amyloidosis and wild-type transthyretin (ATTRwt) amyloidosis.

Purpose
We aimed to investigate prevalence and prognostic implications of cardiac amyloidosis of any etiology on outcomes of hospitalized patients with heart failure (HF) in Germany.

Methods
We analyzed data of the German nationwide inpatient sample (2005–2018) of patients hospitalized for HF (including myocarditis with HF and heart transplantation with HF). HF patients with amyloidosis (defined as cardiac amyloidosis [CA]) were compared with those HF patients without amyloidosis and impact of CA on outcomes was assessed (source: Research Data Center (RDC) of the Federal Statistical Office and the Statistical Offices of the federal states, DRG Statistics 2005–2018, and own calculations).

Results
During this fourteen-year observational period 5,478,835 hospitalizations of HF patients were analyzed. Amyloidosis was coded in 5,407 hospitalizations of HF patients (0.1%). Prevalence of CA was 1.87 hospitalizations per 100,000 German population. CA patients were younger (75.0 [IQR 67.0/80.0] vs. 79.0 [72.0–85.0] years, p&lt;0.001), predominantly male (68.9%) and had a higher prevalence of cancer (14.8% vs. 3.6%, P&lt;0.001) compared with HF without amyloidosis. Although patients without amyloidosis had a pronounced cardiovascular risk profile -especially arterial hypertension (45.4% vs. 35.6%; p&lt;0.001) and diabetes mellitus (38.9% vs. 18.5%; p&lt;0.001)- and a higher prevalence of concomitant coronary artery disease (40.5% vs. 34.5%; p&lt;0.001) and chronic obstructive pulmonary disease (17.1% vs. 9.4%; p&lt;0.001), adverse in-hospital events including necessity of transfusions of blood constituents (7.1% vs. 5.4%, p&lt;0.001) and cardio-pulmonary resuscitation (CPR, 2.7% vs. 1.4%; p&lt;0.001) were more frequent in CA. CA was independently associated with acute kidney failure (OR 1.40 [95% CI 1.28–1.52], p&lt;0.001), CPR (OR 1.58 [95% CI 1.34–1.86], p&lt;0.001), intracerebral bleeding (OR 3.13 [95% CI 1.68–5.83], p&lt;0.001) and in-hospital mortality in the 6th and 8th decade of life (6thdecade: OR 1.40 [95% CI 1.01–1.94], p=0.042; 8thdecade: OR 1.18 [95% CI 1.03–1.35], p=0.02).

Conclusions
CA was identified as an independent risk factor for complications and in-hospital mortality in HF patients. Physicians should be aware of this issue concerning treatments and monitoring of CA-patients.

Funding Acknowledgement
Type of funding sources: None.
Both short-and long-term treatment with the direct AMP kinase activator PXL770 improves cardiac function in ZSF-1 rats
Authors: Stephan Y , Souille M , Larcheveque M , Gluais-Dagorn P , Hallakou-Bozec S , Nicol L , Mulder P 
Published: October 2021

Abstract

Introduction
AMPK is a central energy sensor with cardioprotective effects, and its activation has emerged as a target for the treatment of metabolic syndrome-related cardiac dysfunction. PXL770 is the first direct AMPK activator under clinical development, currently investigated for the treatment of NASH. Since potential cardiac benefits of PXL770 have not been previously assessed we investigated whether short- and long-term PXL770 treatment exerts protective cardiac effects in rats with metabolic syndrome.

Methods
ZSF-1 rats were treated with PXL770 (150 mg/kg orally BID for 90 days initiated at the age of 12 weeks, or for 7 days initiated at the age of 23 weeks) in order to determine left ventricular (LV) function and remodeling.

Results
After 90 days, untreated ZSF-1 rats showed signs of LV diastolic dysfunction, illustrated by the increase in LV end-diastolic pressure (LV EDP; 5.58±0.57 and 8.28±1.02 mmHg in lean and ZSF-1 rats, respectively; p&lt;0.05) and in LV end-diastolic pressure volume-relation (LV EDPVR; 1.10±0.23 and 5.44±0.65 mmHg/RVU in lean and ZSF-1 rats, respectively; p&lt;0.05) with preserved LV systolic function, illustrated by the slight decrease in LV fractional shortening (LV FS; 46±1 and 42±1% in lean and ZSF-1 rats, respectively; p&lt;0.05) and similar LV end-systolic pressure (LV ESP; 173±10 and 197±6 mmHg, respectively) or LV end-systolic pressure volume-relation (LV ESPVR; 32.7±4.2 to 28.6±1.4 mmHg/RVU, respectively). LV diastolic dysfunction was associated with a significant increase in LV tissue collagen density (2.62±0.17 and 4.03±0.13%, respectively) without an alteration in LV weight (1.27±0.02 to 1.22±0.03 g; respectively)
Short- and long-term treatment with PXL770 improved LV diastolic function in treated ZSF-1, illustrated by the reduced LV EDP (5.34±0.93 and 5.98±0.94 mmHg, short- and long-term PXL770, respectively) and the reduced LV EDPVR (3.31±0.43 and 2.73±0.16 mmHg/RVU, respectively; p&lt;0.05 vs untreated ZSF-1). Simultaneously LV FS was significantly increased (52±1 and 50±1%, respectively; p&lt;0.05 vs untreated ZSF-1), as well as LV ESPVR (34.6±1.4 and 33.0±0.9 mmHg/RVU, respectively; p&lt;0.05 vs untreated ZSF-1). The improvement of diastolic function was associated with a reduction in LV weight (1.19±0.04 and 1.17±0.02 g, respectively; long-term PXL770 p&lt;0.0.5 vs untreated ZSF-1) and a significant reduction in collagen density after long-term PXL770 (3.35±0.12%; p&lt;0.05) but not short-term PXL770 (4.22±0.30%).

Conclusion
These results suggest that PXL770 exerts protective effects on cardiac function and structure in developing or established cardiomyopathy. Thus, by directly activating AMPK, the PXL770 appears promising for the treatment of cardiac dysfunction associated with metabolic diseases.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Poxel SA
Impact of pulse pressure on clinical outcome in extracorporeal cardiopulmonary resuscitation (eCPR) patients
Authors: Rilinger J , Riefler A M , Bemtgen X , Jaeckel M , Zotzmann V , Biever P M , Duerschmied D , Benk C , Trummer G , Kaier K , Bode C , Staudacher D L , Wengenmayer T 
Published: October 2021

Abstract

Background
Hemodynamic response after successful extracorporeal cardiopulmonary resuscitation (eCPR) is very heterogeneous. Pulse pressure (PP) as an easy to access surrogate parameter and correlate for myocardial damage or recovery from it, might be a valuable tool to estimate the outcome of these patients.

Purpose
To investigate the predictive value of the surrogate parameter PP in eCPR patients.

Methods
We report retrospective data of a single-centre registry of eCPR patients, treated at our Interdisciplinary Medical Intensive Care Unit between 01/2017 and 01/2020. The association between PP of the first 10 days after eCPR and hospital survival was investigated. Moreover, patients were divided into three groups according to their PP (low (0–9 mmHg), mid (10–29 mmHg) and high (≥30 mmHg)) at each time point.

Results
143 patients (age 63 years, 74.1% male, 40% OHCA, average low flow time 49 min) were analysed. Overall hospital survival rate was 28%. A low PP both early after eCPR (after 1, 3, 6 and 12 hours) and in the further course after day 1 to day 8 was associated with reduced hospital survival. At each time point (1 hour to day 5) the classification of patients into a low, mid and high PP group was able to categorize the patients for a low (5–20%), moderate (20–40%) and high (50–70%) survival rate. A multivariable analysis showed that the mean PP of the first 24 hours was an independent predictor for survival (p=0.008, figure 1).

Conclusion
In this analysis, PP occurred to be a valuable parameter to estimate survival and maybe support clinical decision making in the further course of patients after eCPR.

Funding Acknowledgement
Type of funding sources: None. Figure 1. Survival of eCPR patients by mean 24hPP
Coronary microvascular function in patients with angina with no obstructive coronary artery disease-What factors affect it clinically or angiographically?
Authors: Teragawa H , Akazawa R , Oshita C , Uchimura Y , Orita Y 
Published: October 2021

Abstract

Background
In the clinical setting, we have often experienced patients with angina with no obstructive coronary artery disease (ANOCA), and it has been proposed that the presence of coronary microvascular dysfunction (CMD) play a pivotal role in the pathogenesis of ANOCA. Thus, it is important to assess coronary microvascular function (CMF). However, it has not been clarified what clinical factors or lesion characteristics on coronary angiography (CAG) affect CMF. Thus, we investigated the relationship between CMF and clinical factors or lesion characteristics on CAG in patients with ANOCA.

Methods
Thirty-four patients with chest pain, who underwent CAG, spasm provocation test (SPT) and CMF test, were enrolled. We excluded patients who had moderate coronary stenosis (% stenosis &gt;30%). In the SPT with acetylcholine for left coronary artery and right coronary artery (RCA), the coronary spasm was defined as &gt;90% narrowing of coronary artery on CAG accompanied with chest symptoms and/or ST-T changes on ECG during SPT, and coronary microvascular spasm (MVS) was defined as ≤90% narrowing of coronary artery on CAG with accompanied with chest pain and ST-T changes during SPT. In each coronary artery, the presences of atherosclerosis (20%≤%stenosis≤30%), focal spasm (spasm occurred within one segment of AHA classification), diffuse spasm (spasm occurred over two segments of AHA classification) and MVS, were checked. In the CMF test with a pressure-wire during adenosine triphosphate infusion, the index of microvascular resistance (IMR) was measured. IMR values were obtained in 34 of the left anterior descending coronary artery (LAD) and 12 in RCA. In each patient, conventional coronary risk factors, blood chemical parameters, peripheral endothelial function such as flow-mediated dilation (FMD) of brachial artery and left ventricular mass index (LVMI) were checked.

Results
In 34 patients, clinical factors including blood chemical parameters, FMD and LVMI, except for smoking status did not affect IMR values on LAD. Only the smoking status was associated with IMR values as follows: median IMR values were 44, 22 and 25 in current smokers (n=5), past smokers (n=8) and never smokers (n=21, p=0.03), respectively. In 46 coronary arteries, the presence of atherosclerosis, the type of the coronary spasm, such as focal and diffuse spasm and MVS, did not affect the IMR values, however, it was significantly higher in the RCA (median 38) than that in the LAD (median 26, p=0.02).

Conclusion
These results suggest that smoking status affected CMF in patients with ANOCA, suggesting the possibility of improvement of CMF by stop smoking in such patients. In addition, in the assessment of CMF, it may be important to take into account which coronary artery being evaluated.

Funding Acknowledgement
Type of funding sources: None.
Myocardial ischaemia of non-obstructive origin as a cause of new onset anginal chest pain in the long COVID syndrome
Authors: Espejo C , Mejia-Renteria H , Travieso A , Gonzalo N , Fernandez S , Capote M L , Vedia O , Wang L , Nunez-Gil I , Grande Ingelmo J M , Fernandez Rozas I , Olmos C , Vivas D , Escaned J 
Published: October 2021

Abstract

Background
New-onset chest pain occurs in around 20% of patients with long COVID syndrome (LCS). Being the vascular endothelium one of the targets of the SARS-CoV-2 virus, we hypothesized that new onset anginal symptoms in LCS could be due to endothelium dysfunction and other non-obstructive causes of myocardial ischaemia.

Methods
We investigated 11 consecutive patients who developed new onset anginal chest pain, suggestive of myocardial ischaemia, after documented SARS-CoV-2 infection. Intracoronary assessment included endothelium-dependent evaluation with acetylcholine testing (Ach), and endothelium-independent assessment with coronary flow reserve (CFR) and microcirculatory resistance (MR). Criteria for positiveness of these tests and medical treatment recommendation were obtained from 2019 ESC guidelines and 2020 EAPCI consensus document on ischaemia with non-obstructive coronary arteries (INOCA).

Results
Mean patient age was 56 years (SD ± 15); 10 (91%) were female. In the acute COVID-19 phase, 4 patients (36%) had had pulmonary infiltrates and 2 (18%) required hospitalization. Conclusive non-invasive tests were obtained in 7 (64%), showing exercise-related myocardial ischaemia in 6 (86%). Coronary angiography ruled out obstructive epicardial stenoses in all the patients. Ach testing revealed abnormal endothelium-dependent responses in 9 (82%) patients: 5 (56%) had epicardial vessel and 4 (44%) microvascular spasm. Endothelium-independent assessment was abnormal in 6 (54%) cases, with abnormal CFR in 2 (33%), abnormal MR in 2 (33) and both abnormal CFR and MR in 2 (33%) patients. The most frequent endotype was combined endothelium dependent- and independent abnormalities (6/9, 67%). Stratified medical treatment according to endotype led to significant improvement in Seattle Angina Scores for angina frequency (+22 points, p=0.013) and a notable trend towards angina stability (+25 points, p=0.093) at a mean follow-up time of 222 days.

Conclusions
Myocardial ischaemia of non-obstructive origin is common in patients with chest pain and LCS. Vasomotor abnormalities related to endothelial dysfunction occurred in 82% of patients, frequently associated to impaired microvascular vasodilation or high microvascular resistance. Stratified medical treatment led to significant improvement in angina stability and frequency.

Funding Acknowledgement
Type of funding sources: None.