bluuebunny/crossref_metadata_2025_split huggingface dataset:
Continuation of beta-blockers at discharge is associated with improved outcome in patients with HFpEF and concomitant moderate aortic stenosis
Authors: Shumkova M , De Oliveira E O , Hrubyak L H , Beles M B , Bertolone D T B , Ratti A R , Adeo L A , Viscusi M V , Barbato E B , Wyffels E W , Vanderheyden M V , Van Camp G V C , Herman R H , Bartunek J B , Penicka M P 
Published: October 2024

Abstract

Background
In patients with severe aortic stenosis or decompensated heart failure with preserved ejection fraction (HFpEF), beta-blockers are usually discontinued despite the absence of unequivocal evidence. The data on the effect of beta-blockers in patients with moderate aortic stenosis (MAS) are scarce.

Aim
To investigate the relationship between beta-blocker use and outcome in patients with MAS, who were hospitalized for decompensated HFpEF.

Methods
The current study includes 61 patients admitted for decompensated HFpEF with concomitant MAS. The mean age of the population was 82.7±7.59 years old and 41% were females. The diagnosis MAS was established on criteria including aortic valve area between 1-1.5 cm², mean gradient - 20-39 mmHg, and max velocity between 3-3.9 m/s. For those with borderline measurements, the Doppler Velocity Index (DVI) was calculated (DVI &lt; 0.25 indicates severe aortic stenosis). All echocardiographic data were assessed by an experienced echocardiographer. Patients with previous aortic valve replacement and a severe mixed of multivalvular disease were excluded.

Result
The median follow-up was 52 months (interquartile range 34-63 months). During this period 38 patients (62.3%) died from any cause while 42 (68.9%) individuals experienced a composite endpoint, of all-cause death or hospitalization due to worsening HFpEF. In survivors, we observed higher prescription of beta-blockers at hospital discharge (66% vs. 34%, p&lt;0,05) and better diastolic function than in patients with endpoints. In multivariate Cox regression analysis the use of beta-blockers (HR = 0,27; 95% CI 0,13-0,57; p&lt;0.01) and better diastolic function, defined as higher septal e` (HR=0,76; 95% CI 0,61-0,94; p=0.01) were identified as independent predictors for both - survival and composite endpoint (Figure 1). Advanced age was recognized as an associated factor for outcomes.

Conclusion
In the present study, continuation of beta-blockers at discharge was independently associated with better survival in patients with decompensated HFpEF and concomitant MAS. It remains to be addressed in future studies, whether or not beta-blockers should be started in these patients or if there is any prognostic interaction between beta-blockers and aortic valve intervention for MAS.Figure 1.Kaplan-Meier survival curve
Reduced stroke volume by resting 2-dimensional echocardiography negatively affects survival in patients with abnormal ejection fraction
Authors: Ciampi Q , Cortigiani L , Zagatina A , Kasprzak J D , Wierzbowska-Drabik K , Haberka M , Djordjevic-Dikic A , Rigo F , Gaibazzi N , Pitino A , Tripepi G L , Rodriguez-Zanella H , Villari B , Pellikka P A , Picano E 
Published: October 2024

Abstract

Background
Abnormal (&lt;50%) ejection fraction (EF) is a cornerstone of risk stratification and therapy, but also an imperfect proxy of left ventricular (LV) cardiac pump function, better assessed with stroke volume (SV).

Aim
To assess the value of SV in stratifying risk of patients with abnormal EF.

Methods
In a prospective, observational, multicenter study, we recruited 746 patients (age 66± 11 years, 536 males, 72%, 359 with previous myocardial infarction, 48%) with chronic coronary syndromes (CCS) and EF &lt;50% referred for resting transthoracic echocardiography with technically successful 2-dimensional volumetric echocardiography in 17 accredited laboratories. We quantitatively assessed LV end-diastolic volume (EDV) and end-systolic volume (ESV) by Simpson’s biplane method. EF (EDV-ESV/EDV) and SV (EDV-ESV) were calculated from LV volumes. The outcome end-point was all-cause death.

Results
EF was 39±9%, SV 48±20 ml. There were 100 all-cause deaths during a median follow-up of 796 days (interquartile range 420-1286 days). Receiver-operating curve analysis identified SV≤31.4 ml/b as the best cut-off for predicting mortality. At multivariable analysis, after adjustment for age and prior myocardial infarction, EF &lt;40% and SV ≤31.4 ml/b were significantly associated with decreased survival (HR 2.09, 95%, confidence intervals 1.09-4.01, p=0.024). The annual mortality was lowest (3.19%) in the group with mildly reduced (40-49%) EF and normal (&gt;31.4 ml) SV, and highest (8.30%) in patients with both reduced EF and abnormal SV: see figure.

Conclusion
Patients with CCS and abnormal EF are a prognostically heterogeneous group, and the mortality rate is almost 3-times worse in patients with reduced EF and abnormal SV compared to patients with mildly reduced EF and normal SV. A simple resting volumetric two-dimensional echocardiography can offer an efficient risk stratification, beyond EF, with no extra imaging or analysis time.Figure
Comparative outcomes between empagliflozin and dapagliflozin in heart failure: real world multi-center cohort study
Authors: Bu S , Ahn H S , Jung M H , Lee D , Hwang Y M , Cho J S , Yi J E , Kim H , Kim S , Kim S H 
Published: October 2024

Abstract

Introduction
Heart failure (HF) is a significant global health concern, and sodium-glucose cotransporter-2 (SGLT2) inhibitors, such as dapagliflozin and empagliflozin, have emerged as important therapeutic options. However, their comparative effectiveness in a real-world population remains uncertain.

Purpose
The purpose of this multicenter, population-based cohort study was to investigate and compare the outcomes associated with dapagliflozin and empagliflozin use in patients with heart failure. We sought to understand whether these SGLT2 inhibitors had differential effects on cardiovascular events in a real-world setting.

Methods
We analysed data from a clinical data warehouse encompassing seven medical centers. Subjects diagnosed with heart failure between January 2021 and November 2023, who were prescribed dapagliflozin or empagliflozin, were included. We conducted one-to-one propensity-score matching, ensuring that the dapagliflozin and empagliflozin groups were comparable in baseline characteristics. The primary outcome was a composite of cardiovascular (CV) death or hospitalization for HF, analysed as the first event occurring after starting each medication. Secondary outcomes included individual components, all-cause death, and CV hospitalization.

Results
Propensity-score matching made a balanced cohort of 6,281 patients (3,111 in the dapagliflozin group and 3,170 in the empagliflozin group). The median follow-up duration was 16.0 months. In the propensity-score matched cohort, dapagliflozin and empagliflozin showed no significant difference in the primary outcome (8.8% versus 7.8%, hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.77-1.08, p=0.276). Similar findings were observed in secondary outcomes. Subgroup analysis revealed potential benefits of empagliflozin in patients with diabetes mellitus (DM) (7.8% versus 5.6%, HR 0.73, 95% CI 0.55-0.98, p=0.039).

Conclusion
This study suggests that dapagliflozin and empagliflozin have similar clinical outcomes in the management of heart failure in a real-world setting. However, empagliflozin showed result in improving outcomes for HF patients with DM. Further research is warranted to validate these findings and guide clinical decision-making in the individualized management of heart failure.Baseline characteristicsSubgroup analysis
Effects of anakinra on patients with heart failure below and above 60 years of age
Authors: Golino M , Moroni F , Canada J , Del Buono M G , Hogwood A , Denicolai M , Van Tassell B , Abbate A 
Published: October 2024

Abstract

Background
Anakinra, an interleukin-1 (IL-1) blocker, is being explored in heart failure (HF) to improve cardiorespiratory fitness (CRF). CRF declines with increasing age.

Purpose
We aimed to determine the influence of anakinra on CRF in aging patients with HF.

Methods
We analyzed data from 73 patients with HF (55 [51-62] years, 37 (51%) female) treated with anakinra 100 mg subcutaneously daily. Patients were stratified into two groups according to a predetermined cut-off age of 60 years. We measured peak oxygen consumption (peak VO2) and C-reactive protein (CRP), a surrogate for IL-1 activity.

Results
We included 49 (67%) patients with age &lt;60 years and 24 (33%) with age ≥60 years. The duration of treatment with anakinra was 4 [2-12] weeks. Age was negatively correlated with peak VO2 at baseline and during treatment with anakinra (Spearman’s Rho= -0.375, p=0.001 and Rho= -0.334, p=0.004, respectively). Younger patients had higher baseline peak VO2 (15.2 [12.4–17.7] vs 12.4 [10.3–14.3] mLO2·kg-1·min-1, p=0.001) but similar CRP (6.6 [3.6-16.6] vs 5.1 [2.7-11.2] mg/L, p=0.18). In both groups, anakinra decreased CRP (&lt;60 years: from 6.6 [3.6–16.6] to 1.5 [0.9–3.8] mg/L, p&lt;0.001; ≥60 years: from 5.1 [2.7–11.2] to 1.0 [0.5–3.4] mg/L, p&lt;0.001)(Figure 1A) and increased peak VO2 (&lt;60 years: from 15.2 [12.4–17.7] to 16.0 [14.0–18.7] mLO2·kg-1·min-1, p=0.036; ≥60 years: from 12.4 [10.3–14.3] to 13.7 [11.7–15.8] mLO2·kg-1·min-1, p&lt;0.001)(Figure 1B). No significant differences in interval changes were observed between the groups.

Conclusions
Older patients with HF have a greater impairment in CRF than younger patients, yet they appear to benefit similarly from treatment with anakinra.Figure 1
Efficacy of sotagliflozin by diabetes duration: a secondary analysis of SCORED
Authors: Aggarwal R , Bhatt D , Szarek M , Davies M , Banks P , Pitt B , Steg G 
Published: October 2024

Abstract

Background
Sotagliflozin is a sodium-glucose cotransporter (SGLT) 1 and SGLT2 inhibitor. SCORED randomized patients with type 2 diabetes (DM) and high cardiovascular (CV) risk to sotagliflozin or placebo.

Purpose
We evaluated if diabetes duration affects HF and CV outcomes when comparing sotagliflozin with placebo in SCORED, as diabetes duration can modify CV risk.

Methods
SCORED enrolled patients with DM (hemoglobin A1c ≥7%), chronic kidney disease (glomerular filtration rate of 25-60 mL/minute per 1.73 m2), and CV risk factors. Patients were randomized to sotagliflozin compared with placebo.
Patients in SCORED were stratified by diabetes duration, into categories of &lt;10 years, 10-19 years, or ≥20 years. The primary endpoint was total CV death, hospitalization for HF, or urgent visit for HF. Secondary endpoints were total hospitalization for HF or urgent visit for HF, as well as total CV death, nonfatal myocardial infarction, and nonfatal stroke (MACE).
Outcomes were assessed using marginal proportional hazard models stratified according to HF criteria and geographic region where non-CV death was a competing terminal event. Subgroup analyses were assessed with natural cubic splines of interaction between treatment and continuous diabetes duration.

Results
In SCORED, 10,579 (99.9%) of 10,584 patients had complete data on diabetes duration, with 2412 (22.8%), 4424 (41.8%), 3743 (25.9%) having diabetes duration of &lt;10, 10-19, and ≥20 years respectively. Median (Q1, Q3) diabetes duration was 16.4 years (10.4, 22.4 years), while mean hemoglobin A1c was 8.6%, 8.7%, and 8.7% respectively by diabetes duration.
The rate of the primary endpoint was lower in the sotagliflozin group (5.6 events per 100 patient-years [p-y]) compared with the placebo group (7.5 events per 100 p-y) (HR: 0.74; 95% CI: 0.63, 0.88). Event rates among diabetes duration subgroups indicated that rates in both the placebo group and relative treatment benefit increased with increasing diabetes duration, with 5.6 vs 5.8 events per 100 p-y, 6.1 vs 7.4 events per 100 p-y, and 4.6 vs 8.5 events per 100 p-y for diabetes duration &lt;10, 10-19, and ≥20 years respectively. Spline analysis indicated increasing treatment benefit with increasing duration when modeled continuously (Figure Panel A; PSpline=0.02). Similar findings were observed for the secondary HF outcome of hospitalization for HF or urgent visit for HF, with increased treatment benefit with duration (Figure Panel B; PSpline=0.10).
Total MACE was lower in the sotagliflozin group (4.8 events per 100 patient-years) than in the placebo group (6.3 events per 100 patient-years) (HR: 0.77; 95% CI: 0.65, 0.91), without significant difference in relative treatment benefit by duration (Figure Panel C; PSpline=0.30).

Conclusions
Sotagliflozin improved HF and MACE outcomes in patients with high CV risk, with increasing treatment benefit for HF outcomes among patients with longer diabetes duration.
Elegibility for Sacubitril/Valsartan in italian clinical practice: insights from the OPTIMA-HF registry
Authors: Paolillo S , Marzano F , Nardi E , Gargiulo P , Agostoni P , Calabro' P , Sinagra G , Indolfi C , Montisci R , Guarnaccia F , Cameli M , Brunetti N , Aloisio A , Carugo S , Perrone-Filardi P 
Published: October 2024

Abstract

Background/Introduction
Guidelines strongly recommend patients with heart failure with reduced ejection fraction (HFrEF) be treated with multiple medications proven to improve clinical outcomes, as tolerated. Among them, angiotensin receptor blocker/neprylisin inhibitor (ARNi) are the foundation of neuro-hormonal blockade in patients with HFrEF, however the degree to which gaps in this medication use and dosing persist in outpatient practice is unclear.

Purpose
To assess the proportion of patients with HFrEF who are eligible for ARNi based on the PARADIGM-HF trial criteria and the association between eligibility and baseline characteristics.

Methods
The OPTIMA-HF (Optimization of Therapy in the Italian Management of Heart Failure) registry included outpatients in Italy with chronic HFrEF receiving at least 1 oral medication for management of HF. Patients were characterized by baseline use and dose of angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blocker (ARB)/ARNI, beta-blocker, mineralocorticoid receptor antagonist (MRA) and sodium glucose co-transporter II inhibitor (SGLT2i). Patient-level factors associated with medication use were examined.

Results
Outpatients with HFrEF from 29 ambulatory cardiology practices and university hospitals in the OPTIMA-HF registry recruited between January 2022 and September 2023 were included. Of 1291 patients, 1018 (79%) met the PARADIGM-HF criteria and 949 of them (93%) were on ARNi. Of the enrolled patients, 342 (27%) were not on ARNi, however only 129 (38%) did not met the PARADIGM-HF inclusion criteria for ARNi prescription. Reasons for not meeting PARADIGM-HF criteria were no beta-blocker background therapy (22%), hyperkalemia (4%), hypotension (15%), chronic kidney disease (65%) and hyperkalemia (79%).
In a logistic regression model not being on ARNi was associated with older age, chronic kidney disease, not being on cardiac resynchronization therapy, lower systolic blood pressure, lower BMI, and higher PAPs (Figure), representing the picture of a more fragile patient net of compliance with the PARADIGM-HF criteria.

Conclusions
Among outpatients with HFrEF in the OPTIMA-HF Registry, 79% met the PARADIGM-HF criteria. Strategies to improve guideline-directed use of HFrEF medications remain urgently needed, and these findings may inform targeted approaches to optimize outpatient medical therapy.
Right ventricular failure following left ventricular assist device implantation
Authors: Laimoud M , Maghirang M J , Hakami E , Mohamed T 
Published: October 2024

Abstract

Background
Left ventricular assist device (LVAD) therapy is a lifesaving option for patients with medical therapy-refractory advanced heart failure.(1) Right ventricular failure (RVF) is a cause of major morbidity and mortality after LVAD implantation.(2,3) Our objective was to get the outcomes and predictors of RVF in adult patients undergoing LVAD implantation.

Methods
This retrospective study enrolled 73 adult patients with LVAD (Heart Mate III) implantation, of them 24(32.9%) patients had RVF after LVAD implantation.

Results
The patients with RVF had statistically significant more frequencies of acute kidney injyry (p&lt;0.001), new need for dialysis(p&lt;0.001), RVAD insertion (p&lt;0.001), total mortality (p=0.012) and on-VAD mortality(p=0.018) with prolonged ICU stay (p&lt;0.001) compared to the non-RVF group respectively. The pre-LVAD pulmonary vascular resistance(PVR) ≥3 WU (OR:2.4, 95%CI: 1.52-7.38, p=0.04) and diastolic pulmonary gradient(DPG) ≥ 7 mmHg (OR:6.4,95%CI: 5.49-18.6, p&lt;0.001) were the independent predictors of RVF after LVAD implantation. Cox proportional regression analysis revealed that RVF was associated with increased risk of death (HR:3.12,95%CI:1.42-6.85, p=0.005).

Conclusion
Early RVF post-LVAD carries significant risks of mortality and multiple morbidities. Concomitant BiVAD implantation needs to be considered in patients with elevated DPG and PVR to avoid post-LVAD RVF.The significant variables of patients.Kaplan-Meier curves of the 2 groups.
Derivation and validation of a multicenter model to identify candidates for advanced HF therapies with high potential to achieve post-LVAD reverse cardiac remodeling
Authors: Maneta E , Taleb I , Kyriakopoulos C , Psotka M , Birks E , Guglin M , Silvestry S , Mehra M , Alharethi R , Fang J , Sideris K , Karra R , Kanwar M , Shah P , Drakos S 
Published: October 2024

Abstract

Background
A subset of advanced heart failure (HF) patients can experience significant improvement in their cardiac structure and function while on left ventricular assist device (LVAD) support, which is among the prerequisites for LVAD weaning.

Purpose
We sought to develop and validate a predictive personalized tool to identify candidates for advanced HF therapies with a high potential to achieve significant improvement in myocardial structure and function post-LVAD. This tool can aid clinicians and patients considering advanced HF therapies options.

Methods
A total of 884 consecutive LVAD patients were enrolled. The derivation and validation cohorts included 509 patients (from three institutions) and 375 patients from another four institutions), respectively. The primary outcome was "significant reverse remodeling", defined as left ventricular ejection fraction (LVEF) ≥40% and LV end-diastolic diameter ≤6 cm within one year on LVAD support. Bootstrap imputation and LASSO variable selection were used to derive a predictive model which was externally validated.

Results
Patients were predominantly white (78%), male (80.1%), 57±14 years old. Overall, 12.8% patients were identified as responders. Four variables associated with reverse remodeling were included in the multivariable model achieving a C-statistic of 0.72 (95% CI: 0.66-0.79) in the derivation and 0.75 (95% CI: 0.67-0.84) in the validation cohort (Figure). We created a calculator for individualized prediction of the probability of cardiac recovery and when applied to the studied population, we identified patients with 0.2%-67.6% chance of significant reverse remodeling (see Figure for patient example).

Conclusions
The Multicenter Recovery Calculator is a predictive tool that provides individualized probability of significant reverse remodeling. This tool may help clinicians and patients to maximize the benefits of both heart transplant and LVAD. Specifically, it may serve to (a) improve patient selection for LVAD as bridge to recovery and (b) benefit transplant waitlist outcomes by prioritizing allocation of donor allografts to patients without a high potential for cardiac reverse remodeling.
Impact of HF etiology on the sustainability of favorable response after LVAD weaning: A VAD Wean Registry analysis
Authors: Maneta E , Kyriakopoulos C , Dranow E , Wever-Pinzon O , Cogswell R , Schultz J , Schwartzman A , Shah K , Macgowan G , Schueler S , Zimpfer D , Jorde U , Selzman C , Patel S , Drakos S 
Published: October 2024

Abstract

Background
A subset of heart failure (HF) patients can experience significant improvement of their cardiac structure and function while on left ventricular assist device (LVAD) support.

Purpose
We sought to investigate the impact of HF etiology on the durability of cardiac improvement and favorable outcomes after LVAD weaning.

Methods
We studied 324 HF patients enrolled in the international multicenter VAD Wean Registry who received a durable continuous-flow LVAD and underwent device support weaning (Figure 1). Indications for VAD weaning included: structural/functional cardiac improvement meeting institutional criteria for "myocardial recovery" (responders) or LVAD-related complications accompanied by variable degrees of cardiac improvement (partial responders). Patients were divided into seven categories based on HF etiology: ischemic cardiomyopathy (CM) (n=30), post-myocarditis CM (n=65), peripartum CM (n=53), valvular CM (n=12), chemotherapy-induced CM (n=14) and idiopathic CM (n=150). The primary outcome was 2-year survival free of transplant or LVAD re-implantation. The secondary outcome was the LVEF, measured by echocardiography at 3, 6, 12 and 24 months post-LVAD weaning.

Results
Patients with idiopathic, peripartum and post-myocarditis CM had higher rate of 2-year survival free of transplant or LVAD re-implantation compared to patients with chemotherapy-induced CM (Figure 2-Panel A) (p-values: 0.009, 0.004, 0.001, respectively). Patients with post-myocarditis CM were also more likely to achieve the primary outcome compared to those with ischemic CM (ICM) (p-value, 0.009). The LVEF changes over time are depicted in the Figure 2-Panel B.

Conclusions
In this multicenter analysis the etiology of HF appears to impact the durability of favorable response after LVAD weaning. The degree of reverse remodeling achieved before VAD weaning and its impact on the durability of response in different HF etiologies warrants further investigation in studies with larger patient population and power.
Impact of digoxin on gastrointestinal bleeding following left ventricular assist device implantation: a systematic review and meta-analysis
Authors: Rahhal A , Habib M B , Alani H , Chapra A , Mahfouz A , Alyafei S , Carr C , Alkhulaifi A , Omar A 
Published: October 2024

Abstract

Introduction
Gastrointestinal bleeding (GIB) is a common complication post Left Ventricular Assist Device (LVAD) implantation for patients with advanced heart failure. Recent observational evidence suggested a potential association of digoxin use and GIB reduction post LVAD; however, the proposed benefit remains uncertain. Therefore, we conducted a systematic review and meta-analysis to assess the impact of digoxin use on GIB post LVAD.

Methods
We performed a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched PubMed and EMBASE for the studies published in English exploring GIB with chronic digoxin use following LVAD implantation, till 15/01/2024. Two independent reviewers assessed the quality and risk of bias of the included studies. A random-effect model was used to combine data. The primary outcome was all-cause GIB associated with digoxin use in comparison to non-digoxin use. Heterogeneity was assessed using Q test and I2, with I2 &gt; 50% indicating marked heterogeneity.

Results
A total of three peer-reviewed observational studies (n= 14277) were included in the analysis of the primary outcome. More than 50% of patients received ACE inhibitors/angiotensin receptor blockers. Digoxin use post LVAD was associated with similar GIB incidence in comparison to non-digoxin use (Odds Ratio [OR]= 0.61; 95% CI, 0.33-1.14, I2= 81%, P=0.12), as shown in Figure 1. Interestingly, one study of 199 recipients of LVAD reported significantly lower gastrointestinal angiodysplasia-induced GIB with digoxin use (3% versus 13%, P=0.039).

Conclusion
Among patients with advanced HF requiring LVAD implantation, the use of digoxin demonstrated similar effectiveness of GIB prevention compared to non-digoxin use. Future studies needed to explore the potential use of digoxin for gastrointestinal angiodysplasia-induced GIB.Figure 1.Forest plot of gastrointestina