bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of CRT response using a novel CRT responder score in an Asian patient population
Authors: Kondo Y , Sasaki S , Ando K , Soejima K 
Published: October 2024

Abstract

Introduction
Cardiac Resynchronization Therapy (CRT) guidelines, derived from trials among U.S. and European patients, assign weaker recommendations to those with midrange QRS duration (&lt;150ms). Patient height and body size may modulate CRT efficacy. Moreover, these factors may affect CRT utilization and efficacy in Asia.

Aim
The purpose of this analysis was to determine the prediction scoring system model for CRT responders in a Japanese patient population.

Methods
We analyzed the database of the Multicenter Prospective Pilot Study to Test LV Intracardiac Conduction Time as a Predictor of CRT Response (BIO|SELECT) which was a single-arm study conducted at 28 hospitals in Japan. This study enrolled patients eligible for a de-novo CRT-defibrillator (CRT-D) based on current guideline indications, who had no recent or planned cardiac surgery and were planned to receive a Sentus ProMRI OTW quadripolar LV lead and a BIOTRONIK CRT-D with multipole pacing feature. Patients were followed for 7 months after implantation. Four accepted parameters to define CRT response [LVESV (cut-off -15%), LVEF (+5%), BNP (-25%), and NYHA class (one class improvement)] were combined into a composite benefit index (CBI) by forming the normalized sum, with CBI = 4.0 meaning response. The CBI was found to be more robust than the individual 4 parameters due to the reduced influence of noise and measurement errors in single parameters. Several factors were studied to create the scoring tool. The CRT responder score was the sum of these individual scores (range 0-100). To construct a predictive scoring system, logistic regression analysis was performed with a backward selection procedure. In addition, the Akaike information criterion (AIC) was applied to determine the best model among those tested. The score was then assigned employing the β coefficient of each variable divided by the reference value. The model's calibration was assessed using the Hosmer-Lemeshow goodness-of-fit test.

Results
A total of 196 patients were enrolled in this study (mean age 69 years, mean LVEF 30%, left bundle-branch block [LBBB] 58%). The Ooccurrence of CRT response during the 7-month follow-up was 54%. Future CRT responders were significantly predicted by low age (&lt; 70 years)(18 points), female (19 points), prior heart failure hospitalization (16 points), body mass index (&lt;20) (17 points), QRS/height (&lt;0.858)(30 points). This score predicted CRT response well (area under curve 0.72; 95% CI 0.643-0.798). When the cut-off of 63 points or more was applied the sensitivity was 0.56, the specificity was 0.72, and the negative predictive value was 0.58.

Conclusions
The CRT responder score is a novel approach for the prediction of CRT response, but should be validated and further improved to increase its predictive value. This approach highlights the role of preventing the development of severe heart failure and could help to identify individuals who might benefit from CRT.
Improving time-efficiency and accuracy in echocardiography: real-time automated measurements of left ventricular global longitudinal strain using deep learning
Authors: Holmstrom V , Smistad E , Dalen H , Stolen S , Lovstakken L , Holte E , Ostvik A , Grenne B 
Published: October 2024

Abstract

Background
Accurate quantification of left ventricular (LV) systolic function is fundamental in echocardiography. LV Global Longitudinal Strain (GLS) offers advantages over LV ejection fraction, being more sensitive, reproducible and offering better prognostic value. However, existing semi-automatic methods are time-consuming and heavily operator-dependent. Additionally, poor image quality and foreshortening decrease accuracy and reproducibility of GLS. As a result, these challenges lead to suboptimal efficiency and underutilization of GLS quantification in clinical practice.

Purpose
Our objective was to develop a deep learning (DL) application for real-time automated measurements of GLS, capable of providing tracking quality and foreshortening feedback during scanning. Subsequently, we aimed to validate the novel method in a prospective cohort study.

Methods
Deep learning networks were trained to identify apical views, identify timing of end-systole and end-diastole, conduct cardiac segmentation, estimate myocardial motion, assess LV length in each view for foreshortening detection, and present real-time visualization of tracking quality and GLS values for three cardiac cycles to the operator for review (Figure 1). The DL method was validated in a prospective cohort of 40 patients included regardless of image quality. Agreement with manual measurements obtained using semi-automatic software (EchoPAC version 204, GE HealthCare, Horten, Norway) was evaluated. Bland-Altman statistics and Pearson's correlation coefficient were used to evaluate agreement and correlation.

Results
Feasibility for real-time DL measurements of GLS was 98%, with one patient excluded due to poor image quality. There was good agreement (Bias 0.7%, LoA: -1.6 to 3.1%, figure 2) and excellent correlation (Pearson’s correlation coefficient of 0.93, p&lt;0.001) between the real-time DL application and manual reference measurements for GLS. Using the DL application during scanning resulted in a 58% (95% CI 56%-61%) reduction in time required for scanning and post-processing to obtain GLS values, compared to using the semi-automatic method. Average time consumption was 2 minutes and 16 seconds for the DL method and 5 minutes and 27 seconds for the reference method.

Conclusion
Using deep learning, real-time fully automated measurement of GLS during scanning is feasible, time-saving, and provides good agreement with reference methods. Real-time measurements also offer the potential to reduce operator-related variability by integrating tools to provide image and tracking quality feedback to the user, ultimately benefiting patients.Application user interfaceAgreement between DL and reference
Optimal anticoagulation strategy for left ventricular assist device patients undergoing thoracentesis: a retrospective study
Authors: Hegde S , Barnett C F , Shah N , Mohammed S 
Published: October 2024

Abstract

Background
Left ventricular assist devices (LVADs) are associated with thromboembolic risks necessitating anticoagulation, yet balancing these risks with bleeding concerns remains challenging. Current practice involves warfarin with a target INR of 2-3 alongside anti-platelet therapy. However, consensus on anticoagulation management is lacking, particularly during sub-therapeutic INR or procedural settings. Common strategies include bridging anticoagulation with heparin or enoxaparin, temporary cessation of anticoagulation during the procedure or uninterrupted anticoagulation.

Purpose
To evaluate and compare the incidence of bleeding and thromboembolic events in LVAD patients undergoing thoracentesis, with a focus on determining the optimal anticoagulation strategy during procedures.

Methods
Retrospective data was collected over one year from LVAD patients undergoing thoracentesis at a large academic center. Patients were categorized into ‘bridge’ (received intravenous heparin for bridging during thoracentesis) and ‘no-bridge’ (did not receive bridging anticoagulation) groups. Warfarin was paused before procedure and resumed after procedure in both groups. Baseline characteristics, including age, sex, race, BMI, LVAD type, and INTERMACS profile, were recorded. Primary outcomes were major bleeding and thromboembolic events within 30 days of warfarin cessation. Statistical analysis used t-test/Wilcoxon for continuous variables and Chi-square/Fisher exact test for categorical variables. A p-value &lt;0.05 was considered significant.

Results
During the study, twenty LVAD patients underwent thirty-two thoracenteses (nineteen bridge, thirteen no-bridge). The demographics were similar among the two groups. Warfarin was held for an average of 5.5 ± 4.6 days before and resumed 4.1 ± 4.6 days after the procedure in the bridge group and 3.8± 3.2 days before and 1.7 ± 2.5 days after in the no-bridge group. Major bleeding occurred in 73.7% of bridge group cases versus 30.8% of no-bridge group cases (p=0.059). 63.2% of bridge group patients had a bloody pleural effusion on thoracentesis compared to 46.2% of no-bridge group patients (p value= 0.34). Average transfusion requirements were 2.8 units and 2 units in the bridge and the no-bridge groups respectively (p=0.658). Thromboembolic events included a 10.5% ischemic CVA rate in the bridge group, with none in the no-bridge group. No other arterial thromboembolic events, pump thrombosis or DVT/PE were observed in either group.

Conclusion
In LVAD patients undergoing thoracentesis, a non-bridging strategy does not appear to elevate the risk of thrombosis compared to a bridging approach. Moreover, the incidence of bleeding, while not statistically significant, trended higher in the bridging group.
Association of gut microbiota imbalance with risk of postoperative infections in patients with left ventricular assist device
Authors: Takenaka S , Nagai T , Sato T , Kamiya K , Mizuguchi Y , Takahashi Y , Naito S , Saiin K , Kazui S , Hamaya T , Mori Y , Ishizaka S , Wakasa S , Anzai T 
Published: October 2024

Abstract

Background
Infections are the most common complications following left ventricular assist device (LVAD) implantation and associated with adverse events. Gut microbial imbalance may predispose to mucosal colonization with pathogens, resulting in a risk of subsequent serious infections. However, it remains unclear whether gut microbiota imbalance is associated with postoperative infections in patients with LVAD.

Purpose
The aim of this study was to investigate whether gut microbiota imbalance was associated with postoperative infections in patients with LVAD.

Methods
We prospectively examined 22 consecutive LVAD patients who were admitted to a university hospital for routine check-ups and had stool cultures taken between March 2022 and December 2023. All patients had no signs of infection. The patients were divided into two groups according to positive (normal bacterial flora and other bacteria including Streptococcus viridans, Klebsiella, or Extended-spectrum β-lactamase Escherichia coli; n = 7) and negative (normal bacterial flora only; n = 15) for stool culture. The primary outcome was serious infection requiring hospitalisation treated with intravenous antimicrobial agents.

Results
Patients were predominantly male (68%) and the median age was 49 (interquartile range [IQR] 29-58) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices, time on LVAD support, the history of infection, or antibiotics use within six months between the groups. During a median follow-up period of 316 days (IQR 242-559), the primary outcome occurred in seven patients (32%), including four hospitalisation for driveline infections, two pneumoniae and bacterial bloodstream infections, and one lung abscess and bacterial bloodstream infection. Kaplan–Meier analysis showed that the adverse events more frequently occurred in LVAD patients with positive for stool culture (P = 0.010) (Figure). A multivariable Cox regression analysis showed that positive for stool culture was independently associated with an increased subsequent risk of the primary outcome (hazard ratio 6.99, 95% confidence interval 1.17-41.7, P = 0.033), even after adjustments for age, male, body mass index, diabetes, INTERMACS profile, mechanical circulatory support, serum creatinine, serum albumin, and white blood cell count, which are known to be strong determinants of worse clinical outcomes in patients with LVAD.

Conclusions
In patients with LVAD, gut microbial imbalance was associated with subsequent serious infections. These findings suggest that the screening of stool culture might be useful for early identification of high-risk patients for infectious complication after LVAD implantation.
Establishing normal global longitudinal strain values in heart transplant patients: a novel approach to enhancing detection of rejection and cardiac allograft vasculopathy
Authors: Albulushi A , Al-Abri U 
Published: October 2024

Abstract

In the realm of heart transplantation, accurate cardiac monitoring is pivotal for patient outcomes. This study pioneers in filling a critical void by delineating the normative values of Global Longitudinal Strain (GLS), specifically tailored for heart transplant recipients, distinguishing them from the general population. We conducted a retrospective analysis on a cohort of 110 patients who underwent heart transplantation, meticulously compiling echocardiographic data over the first 18 months post-operation. Our research focused on two primary indicators of cardiac function: Ejection Fraction (EF) and Global Longitudinal Strain (GLS).
The data indicated that EF values remained within the normal range and relatively stable throughout the monitoring period. In contrast, GLS values exhibited a gradual increase over time, suggesting a post-transplant myocardial adaptation process. However, these GLS values did not reach the established reference ranges for non-transplanted, healthy hearts, highlighting the distinctive physiological landscape of transplant recipients. Our study elucidates the superior sensitivity of GLS in detecting subtle myocardial changes that might precede clinically apparent dysfunction, advocating its utility as a crucial surveillance tool for this demographic.
By pinpointing the modified GLS benchmarks applicable to post-heart transplant patients, our findings advocate for a recalibrated echocardiographic assessment protocol. Such a protocol can significantly enhance the surveillance for post-transplant complications, most notably graft rejection and the onset of cardiac allograft vasculopathy (CAV). The study posits that incorporating these refined GLS thresholds into routine post-transplant evaluations could facilitate early intervention, potentially mitigating adverse outcomes and improving the long-term prognosis for heart transplant recipients. Thus, our research underscores the need for updated clinical guidelines that integrate these novel echocardiographic insights, paving the way for improved patient-centric cardiac care in the transplant setting.
Treatment with mTOR Inhibitors as primary immunosuppression after combined heart and kidney transplantation
Authors: Alnsasra H , Asleh R , Khalil F , Akiki E , Briasoulis A , Dean P , Bentall A , Kushwaha S 
Published: October 2024

Abstract

Background
It has been hypothesized that combined heart and kidney transplantation (HKT) may lead to immune modulation and attenuation of cardiac allograft vasculopathy (CAV) progression. Sirolimus (SRL) has been shown to mitigate the progression of CAV and confer renal protection. With the increasing use of SRL as primary immunosuppression in heart transplant (HT) recipients, the effect of HKT on CAV progression compared to HT-only remains undetermined.

Purpose
We sought to investigate the patterns of conversion from calcineurin inhibitors (CNI) to SRL, and its impact on CAV progression and outcomes in HKT compared to HT-only in a cohort with frequent use of SRL as primary immunosuppression.

Methods
A cohort of 302 patients who underwent either HT only (n=262) or combined HKT (n=40) was analyzed. CAV progression was assessed by measuring the delta (Δ) annual change in plaque volume (PV) normalized to vessel length (PV/VL in mm3/mm) and plaque index (PI) (%) (calculated as the PV to VV ratio) between baseline and last follow-up coronary intravenous ultrasound (IVUS). Clinical adverse outcomes included all-cause death and CAV-associated events. Secondary outcomes included differences in renal function and incidence of SRL-associated proteinuria (defined as Δ urine protein ≥300 mg/24 h at 1 year after conversion to SRL) between HT-only and HKT recipients.

Results
Overall, 217 (72%) patients were converted from CNI to SRL as primary immunosuppression. HT recipients were more likely to be converted to SRL than combined HKT recipients (74% vs. 55%, P=0.01). HKT was associated with significantly higher ΔPV/VL (P=0.01) and a trend toward a higher ΔPI (P=0.06) than HT-only, but this association was markedly attenuated after adjustment to SRL conversion. HKT was associated with similar risk of death (adjusted hazard ratio [HR] 0.69, 95%CI: 0.28-1.71, P=0.43) and CAV-related events (adjusted HR 0.83, 95% CI: 0.30-2.31, P=0.72). Conversion to SRL was significantly associated with decreased risk of death and CAV-related events in the overall cohort. This association was not modified by the type of organ transplantation (Pinteraction=NS), and without a significant effect on estimated glomerular filtration rate (eGFR) or proteinuria.

Conclusions
HKT recipients compared to HT-only were less likely to be converted from CNI to SRL-based immunosuppression and had a greater CAV progression but without significant differences in all-cause mortality or CAV-related events. The clinical benefit and safety of conversion to SRL appeared similar in the HKT and isolated HT cohorts.
Early postoperative Fibrinogen-to-Albumin Ratio prognosticate 6-month procedural success in patients undergoing orthotopic heart transplantation
Authors: Sokolski M , Byszuk P , Ptak J , Przybylski R , Bochenek M , Krupka D , Szwajkowski M , Zakliczynski M 
Published: October 2024

Abstract

Background
The Fibrinogen-to-Albumin ratio (FAR) has emerged as a novel biomarker, integrating liver function and inflammatory reaction with proven prognostic value in heart failure (HF) patients. This study aims to evaluate its significance in advanced HF patients treated with orthotopic heart transplantation (HTx).

Methods
Mean fibrinogen, albumin and FAR values were analyzed one week post-HTx. The primary endpoint of the study was 6-month all-cause mortality. Regression models incorporating parameters significantly different between survivor and deceased groups (troponin, potassium, asparagine aminotransferase [AST]) were developed to assess predictive value of FAR. Additionally, the Spearman's rank correlation between FAR and inflammatory biomarkers (C-reactive protein [CRP], procalcitonin, white blood cells (WBC)] and liver enzymes [AST, alanine aminotransferase [ALT], gamma-glutamyl transpeptidase [GGTP]) were calculated.

Results
The analysis included 104 patients undergoing HTx with a median age of 53 years (44.5-62.5), 82% were male, 44% had ischaemic aetiology of HF. Within 6 months post-HTx 17 patients (16%) died. Mean fibrinogen in all patients was (3.18 ± 0.83), albumin (3.17 ± 0.35) and FAR (1.01 ± 0.28). Deceased patients exhibited lower 1 week post HTx mean fibrinogen (2.46 ± 1.13) compared to survivors (3.30 ± 0.70), lower albumin (2.93 ± 0.43) vs. (3.21 ± 0.32), and lower FAR median (0.73, 0.53-1.16) vs. (0.99, 0.88-1.18), all p&lt;0.05. The post-HTx fibrinogen independently predicted death: (RR 0.37, p=0.003, 95% CI [0.19,0.71]), as did post-HTx albumin: (RR 0.21, p=0.05, 95% CI [0.04,1.0]). FAR was also an independent risk factor: (RR 0.08, p=0.009, 95% CI [0.01,0.54]). There were significant correlations between FAR and CRP (R=0.30, p=0.003), and GGTP (R=0.25, p=0.045). FAR was not significantly correlated with procalcitonin, WBC, AST and ALT.

Conclusions
Early post-HTx fibrinogen, albumin and FAR are independent predictors of an unfavorable prognosis in HF patients undergoing HTx. In contrast to chronic HF, early post-HTx FAR was inversely correlated with mortality. The calculated correlation between FAR, inflammatory markers and liver enzymes suggests limited association with inflammatory processes and liver function in this population.
Baroreflex activation therapy in heart failure patients with reduced ejection fraction: a long-term follow up
Authors: Wang D , Mueller-Leisse J , Hillmann H A K , Eiringhaus J , Berliner D , Karfoul N , Schmitto J D , Ruhparwar A , Bauersachs J , Duncker D 
Published: October 2024

Abstract

Introduction
Heart failure with reduced ejection fraction (HFrEF) is a major public health concern with substantial morbidity and mortality. Overactivation of the sympathetic nervous system is a key pathophysiological process driving heart failure progression. Baroreceptor activation therapy (BAT) targets this autonomic imbalance and is a promising treatment strategy for patients with HFrEF. Current short-term studies indicate that BAT provides symptomatic relief, improvement in left ventricular function and cardiac biomarkers. However, data regarding the long-term effect of BAT on HFrEF are scarce.

Purpose
This study aims to assess long-term outcome in HFrEF patients who underwent BAT.

Methods
Patients with HFrEF who received BAT between 2014-2023 were followed until latest available follow-up. Symptom burden, echocardiography and laboratory testing were assessed before BAT implantation and in subsequent follow ups.

Results
23 patients (mean age 66±10 years, 83% men) with HFrEF were included in the study. Etiology of heart failure was ischemic in 70%. The majority of patients (96%) suffered from NYHA III with a mean left ventricular ejection fraction (LVEF) of 23±8% and NTproBNP of 2463±2922pg/ml. Complication occurred in one patient during BAT implantation (4%). Mean follow-up was 3±2 (max. 7.5) years. BAT reduced NYHA classification in 12 patients (52%) after 1 year, of which 1 patient remained in ameliorated NYHA for 7.5 years. Evolution of NYHA functional class over time is shown in Figure 1. Echocardiographic evaluation revealed significant improvement in LVEF of 9±9% after 1 year (p&lt;0.001) and by 11±9% after 2 years (p=0.005). In long-term a trend towards improved LVEF could be observed (Figure 2). In addition, BAT mildly reduced NTproBNP in the first 2 years (after 1 year non-significantly by -396±1006pg/ml and significantly after 2 years by -566±651pg/ml (p=0.039)). Seven patients reaching recommended replacement time underwent device exchange. Four patients deceased during observation time.

Conclusion
BAT resulted in a substantial reduction in NYHA classification, improvement in LVEF, and a delayed reduction in NTproBNP levels. These findings highlight the long-term efficacy and potential benefits of BAT as a therapeutic intervention for patients with HFrEF.Sankey plot of NYHA class over timeAlteration of LVEF over time
mortality trends and effects of acute pulmonary embolism on acute right heart failure patients: a nationwide perspective
Authors: Devarakonda P , Reddy P , Deekonda S , Ramireddy K , Manoharan S , Moreno P 
Published: October 2024

Abstract

Background
Acute right ventricular failure is a significant cause of death, frequently overshadowed by left heart failure. Despite their frequent coexistence, no studies have correlated the relationship between acute pulmonary embolism (APE) and acute right heart failure (ARHF). Our analysis aims to establish a connection between them and evaluate the mortality trend.

Methods
We investigated NIS 2016–2020 to identify hospitalizations with ARHF. Using a multivariate model adjusted for age and gender, sex and national trends were calculated for mortality and cardiogenic shock among these patients.

Results
A total of 1.8 million hospitalizations with RVHF were identified, with a mean age of 70 years. The trends in mortality and cardiogenic shock among these patients showed a steady increase. Of them, 42,569 patients had concomitant APE. The mortality is significantly higher among ARHF with APE (odds ratio (OR): 2.46, CI (confidence interval): 2.26-2.68, p&lt;0.01). Cardiogenic shock, cardiac arrest, total charges, and LOS are also significantly higher among the concomitant acute PE group, as shown in Table 1 below.

Conclusions
In this study, we observed an increasing trend in ARHF mortalities and cardio›genic shock. We also discovered a high death rate among patients with concurrent APE. More research and diligent monitoring of patients with ARHF in the setting of APE is required to know more about these results.