bluuebunny/crossref_metadata_2025_split huggingface dataset:
Diastolic dysfunction and survival in patients with preserved or mildly reduced left ventricular ejection fraction
Authors: Chan N , Atherton J J , Hammett C , Stewart P , Mallouhi M , Vollbon W , Prasad S B 
Published: October 2024

Abstract

Background
Left ventricular ejection fraction (LVEF) is relatively indiscriminate for prognosis in patients with preserved or mildly reduced LVEF (&gt;40%) following myocardial infarction (MI).

Aims
This study sought to determine the value of guideline-based assessment of diastolic dysfunction (DD) in predicting all-cause and cardiac mortality in patients with a first-ever MI and LVEF&gt;40%.

Methods
A retrospective single centre study involving 2234 patients with a first-ever MI (STEMI or NSTEMI) with LVEF&gt;40% was performed. Clinical, angiographic, and echocardiographic data were obtained from prospectively maintained institutional databases. Outcomes data were obtained from the state-wide registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined as grade 2+3 diastolic dysfunction according to current American Society of Echocardiography/ European Association of Cardiovascular Imaging guidelines.

Results
The mean age of patients was 61.4±12.3 years, 70.7% were males, and 12.1% had 3-vessel disease. The mean LVEF was 55.8±7.2% and 9.1% had significant DD. At a median follow up of 4.5 years, there were 219 deaths (46 cardiac deaths). On Cox proportional hazards multivariable analyses incorporating significant clinical, angiographic, and echocardiographic variables, significant DD was an independent predictor of both all-cause (HR 2.01,95%CI 1.37-2.94, p&lt;0.001) and cardiac (HR 3.97,95%CI 1.98-7.99, p&lt;0.001) mortality.

Conclusions
Significant DD is an independent predictor of all-cause and cardiac mortality following MI in patients with preserved or mildly reduced LVEF and thus effectively re-stratifies prognosis in a subgroup where the LVEF is relatively indiscriminate for survival. The benefit of further investigation and/or treatment in this subgroup needs further study.
Association of renal circulation at acute phase with decongestion level at discharge in patients admitted for acute decompensated heart failure
Authors: Kayama K , Kikuchi S , Sugimoto T , Seo Y 
Published: October 2024

Abstract

Background
In patients admitted with acute decompensated heart failure (ADHF), renal hemodynamics may play an important role in the clinical course during hospitalization based on the close cardio-renal relationship. Superb Microvascular Imaging (SMI), distinguished by its advanced clutter suppression capabilities to reveal microflow details, holds promise for evaluating renal circulation. Consequently, our study aims to explore the association between renal circulation as assessed by SMI and the levels of brain natriuretic peptide (BNP) at discharge as an indicator of decongestion status.

Methods
In a prospective design, 45 ADHF patients were sequentially examined via renal ultrasound with SMI at discharge. The vascular index (VI) by SMI was calculated as the percentage of blood flow signal area in the region of interest. Then, the intra-renal perfusion index (IRPI) as an index of cyclic variation in VI, was calculated as the maximum VI minus the minimum VI within one cardiac cycle in the ROI divided by the Max.VI (Figure A).

Results
The values of IRPI were as follows: at 12h, 0.70±0.04; at 48h, 0.58±0.05; at 1W, 0.50±0.04; and at discharge, 0.61±0.04. The IRPI measured at 48h showed a stronger correlation with BNP at discharge (r = 0.57, p&lt;0.001) than those at the other three points (Figure B). Patients with higher log BNP at discharge (&gt; 2.31: determined by the median value) had significantly higher IRPI and age, and lower hemoglobin levels at 48h, however, there were no significant differences in estimated glomerular filtration rate, ejection fraction, or systolic pulmonary artery pressure at 48h. The area under the curve of IRPI at 48h for higher log BNP at discharge &gt; 2.31 at discharge was 0.746 (sensitivity 100%, specificity 48%).

Conclusion
Early assessment of renal circulation by SMI around 48 hours after ADHF admission may predict congestion resolution at discharge. This underscores the potential utility of SMI in guiding more aggressive decongestive treatment strategies earlier in ADHF.
Empowering patients with heart failure: a digital health solution improved self-care and metabolic outcomes in a randomized controlled trial
Authors: Arnar D O , Gudmundsson E F , Dobies B , Sigurdardottir S , Hrafnkelsdottir T J , Broddadottir H , Gudlaugsdottir G J , Laxdal B , Asgeirsdottir L , Kaernested B , Bragadottir H B , Isberg A , Helgadottir H , Sigurdsson A F , Oddsson S J 
Published: October 2024

Abstract

Background/Introduction
Heart failure is a common cause of morbidity and mortality and poses a significant burden on patients and healthcare providers.

Purpose
The aim of the study was to evaluate whether a digital health program improves quality of life and clinical outcomes for patients with heart failure.

Methods
A single-center, randomized controlled trial (RCT) was conducted with patients receiving standard of care (SoC) at a heart failure outpatient clinic. Patients were randomized (1:1) to receive either SoC alone or SoC with an additional six-month digital health program. The program consisted of remote patient monitoring (RPM) with symptom tracking, disease-specific education, and lifestyle coaching, designed to empower patients with heart failure. After the main program concluded, a six-month maintenance program was initiated, consisting of recurrent educational materials, with reduced coaching- and RPM frequency. The primary endpoint was the 12-item Kansas City Cardiomyopathy Questionnaire (KCCQ-12) at six months. Secondary endpoints included the European Heart Failure Self-care Behaviour Scale-9 (EHFScB-9), 6-question heart failure knowledge questionnaire, and metabolic outcomes. Here we report on the Intention-to-Treat (ITT) population analysis for the primary and significant secondary endpoints at six and 12 months.

Results
The ITT included 175 participants, 86 in the program group and 89 in the control. Program group: mean age (SD) 64.7 (13.2), 66.3% male, 87.2% with NYHA stages I-II. Control group: mean age (SD) 66.2 (11.1) years, 69.7% male, 87.6% with NYHA stages I-II. Median compliance with RPM was 93% and in-app retention was 80% at six months. Results for primary and secondary endpoints are presented in Table 1 and Figure 1. No statistical difference was observed in the KCCQ score between groups at six or 12 months. The program group had statistically significant improvements in EHFScB-9 score at six and 12 months and in heart failure knowledge at 12 months compared to the control group. Metabolic outcomes: a significant difference in glucose levels was also observed between groups at six months, and in HbA1c and triglycerides levels at 12 months.

Conclusions
The difference between groups in the primary endpoint of heart failure symptoms and quality of life, as measured by the KCCQ-12, was not statistically significant. However, significant differences were observed in self-care behaviour and heart failure knowledge, as well as metabolic outcomes at six and 12 months, when compared with standard care alone. These findings, along with good retention and engagement, indicate the value to patients of digital health interventions in the management of heart failure.
Feasibility and efficacy of acetazolamide in the treatment of acute decompensated heart failure
Authors: Iemura Y 
Published: October 2024

Abstract

Background
The ADOVAR trial showed that the addition of acetazolamide to loop diuretics could be expected to result in more rapid diuresis and shorter hospital stays in patients with acute decompensated heart failure (ADHF). However, tolvaptan and SGLTII inhibitors are often added for patients with ADHF in Japan.

Method
An inception cohort of patients with ADHF admitted between January 2022 and June 2023 was assessed. We studied baseline characteristics and divided the patients into "acetazolamide-use" and "no-use" groups. After three days of admission, the endpoint was the reduction rate of body weight, urine output, and the Congestion Score Index (CSI) improvement rate.

Results
A total of 222 patients were included (73 of the use group and 149 of the no-use group). Baseline characteristics showed the use of catecholamines, PDE III inhibitors, and SGLTII inhibitors were higher in the use group (30.1% vs. 14.8%; P&lt;0.05, 37.0% vs. 8.1%; P&lt;0.05, and 75.3% vs. 38.3%; P&lt;0.05). The reduction rate of body weight, the amount of urine output, and the CSI improvement rate were higher in the use group (6.5% vs. 4.1%; P&lt;0.05, 2745.8ml/day vs. 2004.8ml/day; P&lt;0.05, and 27.8% vs. 19.2%; P&lt;0.05). A hierarchical multiple regression analysis showed the use of acetazolamide and SGLT II inhibitors were the factors that contributed to the reduction of body weight, the amount of urine output, and the improvement of the CSI (P&lt;0.05).

Conclusion
The addition of acetazolamide to daily medical therapy in patients with ADHF in Japan resulted in a greater incidence of successful decongestion.
Heart failure treatment in the last years of life - a nationwide study of 364,000 individuals
Authors: Lindholm D , Gustafsson S , Cars T , Sundstrom J 
Published: October 2024

Abstract

Background
Heart failure treatment patterns towards the end of life have rarely been studied at large scale. Yet, this is important to assess, since heart failure is a chronic condition with patients on treatment for potentially many years.

Purpose
To investigate treatment patterns in the last years of life in patients with heart failure.

Methods
In a register-based study covering the whole Swedish population between 2007 and 2020, we investigated treatment patterns in the last years of life in 364,480 individuals who died with heart failure. We combined binomial models (to estimate proportion on treatment at death) and Poisson models (to estimate discontinuation rate), to estimate the proportion on each heart failure treatment up to 5 years prior to death, using penalized splines to allow for non-linearities. We also assessed comorbidity patterns over time.

Results
All heart failure treatments saw a gradual discontinuation closer to death, but the discontinuation rate of beta blockers decreased over time, resulting in an increasing proportion of patients on treatment at the time of death (Fig). Also, the pattern of comorbidities changed over time, with an increase in e.g., hypertension and atrial fibrillation, but a decline in ischemic heart disease (63% in 2007 gradually declining to 54% in 2020).

Conclusions
In this nationwide study, we observed a changing pattern of medical treatment of heart failure during the last years of life, most notably with an increasing use of beta blockers. Comorbidities and the shares of heart failure etiologies also changed over time, with an increase in several conditions but a decline in ischemic heart disease. Taken together, this may have important implications for planning and optimizing care for these patients.
The hemodynamic classification system for hemodynamic-related adverse events in left ventricular assist device patients
Authors: Gallone G , Baldetti L , Konicoff M , Ibero J , Maestro-Benedicto A , Morley-Smith A , Monteagudo Vela M , Fiorelli F , Frea S , Vandenbriele C , Panoulas V , Loforte A , De Ferrari G M , Garcia Saez D , Riesgo Gil F 
Published: October 2024

Abstract

Background
Durable left ventricular assist device (LVAD) physiology predisposes to right heart failure (RHF) and aortic insufficiency (AI), recently labelled hemodynamic-related adverse events (HDREs). However, the pathophysiology, incidence, and associated morbidity of HDREs remains largely unsettled due to heterogeneity in data reporting.

Purpose
We sought to validate the recently proposed LVAD Hemodynamic Classification System (HCS) for HDREs.

Methods
RHF and AI HDREs were retrospectively adjudicated, staged (mild to severe) and phenotyped (isolated or combined RHF/AI-HDREs) based on the HCS assessed at 6-month post-LVAD implant among 183 consecutive patients undergoing LVAD implant at a quaternary heart failure center, and either alive at 6-month on support (n=175) or deceased due to late HDREs 1 to 6 months post-LVAD implant (n=8). The primary outcome was a composite of first HF hospitalization or cardiovascular death between 6 and 24 months after LVAD-implant.

Results
At 6-month assessment, RHF-HDRE was adjudicated in all patients, while AI-HDRE could not be adjudicated in 22 (12.0%) patients. Overall, 53 (29.0%) patients developed an RHF-HDRE, and 26 (16.0%) an AI-HDRE (phenotypes: 39 isolated RHF, 15 isolated AI, 11 combined RHF-AI, 3 not-adjudicated). During pre-LVAD assessment, age and pulmonary artery pulsatility index were independently associated with RHF-HDRE; and pre-LVAD AI and systolic pulmonary artery pressure with AI-HDRE. Patients developing the combined RHF-AI phenotype required the most intensive bundle of critical care pre-LVAD implantation, had more frequent pre-LVAD RV dysfunction, the highest rate of early post-LVAD RHF, and the most prominent features of suboptimal left ventricular unloading, RV dysfunction, peripheral congestion, renal damage and impaired functional capacity at 6-month assessment. RHF-HDRE (adj-HR 2.69, 95%CI 1.14-6.34, p=0.024), AI-HDRE (adj-HR 4.21, 95%CI 1.70-10.40, p=0.002) and HDRE phenotype (isolated RHF or AI HDRE vs. no HDRE: adj-HR 2.80, 95%CI 1.03-7.62, p=0.044; combined RHF and AI HDRE vs. no HDRE: adj-HR 4.53, 95%CI 1.33-15.35, p=0.015) were associated with the primary outcome. A graded increase in primary outcome was observed with rising RHF and AI stages.

Conclusions
The LVAD Hemodynamic Classification System for HDREs identifies pathophysiological and clinical clusters of patients with significant prognostic implications. It may help the development of targeted strategies to mitigate HDREs and improve the success of long-term LVAD support.
Long-term outcomes of heart re-transplantation from HCV-viremic donors based on UNOS registry
Authors: Mazur M , Nunez M , Pisani B , Bhat G , Eisen H J 
Published: October 2024

Abstract

Background
The use of hepatitis C virus (HCV) viremic donors increased the heart donor pool, and reduced waitlist time and mortality among first-time single-organ heart transplant (HT) candidates without compromising their post-transplant survival. The outcomes of heart re-transplantation (re-HT) with the use of HCV-viremic donor grafts have not been investigated.

Methods
Using the United Network of Organ Sharing (UNOS) Registry we analyzed all adult patients who underwent single-organ heart re-HT in the United States between January 1, 2016, and December 31, 2022. HCV-viremic donors were defined by a positive nucleic acid amplification test (NAT+). Graft survival rates between HCV-viremic and HCV-non-viremic donor graft recipients were compared using a log rank test.

Results
During the study period, of 18,259 HTs performed, 427 (2.3%) constituted single-organ heart re-transplantations. Recipients of NAT+ grafts (n=19) compared to NAT- grafts (n=408) were more often male (84.2% vs 61.3%, p=0.04). Otherwise, there were no significant differences between the two groups in age, ethnicity, BMI, blood type, history of diabetes rates or stroke, creatinine or bilirubin levels, reason for re-HT, hemodynamics, use of mechanical circulatory support, and waitlist time. Ischemic time, frequency of female donors, HLA, ABO, CMV mismatch rates, and calculated panel reactive antibodies levels were comparable across the two groups. There were no significant differences in demographics or comorbidities rates between HCV-viremic and HCV-non-viremic donors apart from the cause of death. Among the donors of HCV-viremic grafts brain anoxia was reported more often (89.5%) than among HCV-non-viremic donors (40%), p &lt;0.01. Rates of acute rejection treated in the first year after re-HT were comparable across the two groups. Over a mean follow-up of 3.0±2.1 and 3.3±1.8 years after re-HT from NAT- and NAT+ organ donors, respectively, graft survival rate at 1 year was 82% vs. 95% (p=0.3) and at 3 years 79% vs. 89%, respectively (p=0.6) (Figure).

Conclusion
Graft survival rates at 1 and 3 years post-heart re-HT in adult recipients of HCV-viremic donor grafts were comparable to those of recipients of HCV-non-viremic donor grafts. The current study provides compelling preliminary evidence that HCV-viremic donors constitute a viable donor pool for patients in need of heart re-transplantation.
Value-based versus usual care for heart failure patients leads to reduction in cost, hospital admissions and improved survival
Authors: Barbarash S B , Flores J , Zhu L , Cooper K , Siddiqui Y , Caraang C 
Published: October 2024

Abstract

Background
OptumCare (OC) in our city, Nevada established a heart failure (HF) program comprised of a team of outpatient cardiologists including two who are board certified in advanced heart failure. Referred patients are enrolled in the HF program once HF is diagnosed by a cardiologist. Patients are managed by an interdisciplinary team of cardiologists, advanced practice clinicians (APC), registered nurse case managers (RNCM), and a social worker. Patients at higher risk for HF admissions are enrolled in remote patient telemonitoring. In contrast, OC in Arizona utilizes a "usual" care approach of fee-for-service contracted cardiology groups to manage HF patients in outpatient and in-patient settings.

Purpose
A head-to-head comparison was performed between the cohort of patients enrolled in HF program in OC Nevada (treatment group) and patients with HF diagnosis in OC Arizona (control group). The groups were compared on the following measures: medical cost, hospital admissions, and survival rates.

Methods
In this retrospective study, a 1:1 iterative propensity score (PS) matching was performed to closely approximate patient demographics and comorbidities, which resulted in 818 matched pairs (total n=1,636) of the patients with program enrollment or 1st HF diagnosis between March 1, 2019 and June 30, 2022. For Difference-in-Difference Analysis (Diff-in-Diff), generalized linear models were used on PS matched data to test the difference in difference in medical cost and utilizations changes between control and treatment group over a six month period. Log-Binomial regression was used to estimate the relative risk of post period 30-day readmission and hospice enrollment. Kaplan Meier Estimator was used to test the difference in survival rates over time.

Results
Average age of patients was 77.6 years old, and 49% were female. The treatment group resulted in significantly lower overall medical costs per member per month (PMPM), significantly less emergency room (ER) visits, less acute hospital and skilled nursing facility (SNF) admissions, and shorter overall hospital length of stays. The control group was twice as likely to be readmitted to the hospital. Lastly, the treatment group had a significantly better survival rate than the control group. 19% of the patients in the control group expired within 12 months of enrollment vs. 10% of the patients in the treatment group expired during the same time period. Average survival was 142 days in the control group vs. 200 days in the treatment group.

Conclusions
A value-based care approach involving a multidisciplinary team in an outpatient-based cardiology HF program resulted in statistically significant improvement in medical costs, acute care visits/admissions, and survival rates compared to "usual" care approach for HF patients.
Who should be prioritized for screening for adult onset dilated cardiomyopathy among first degree relatives?
Authors: Oh J , Lee J Y , Lee C J , Kang S M 
Published: October 2024

Abstract

Introduction
Familial genetic and cardiovascular screening is highly recommended to detect dilated cardiomyopathy (DCM) in first-degree relatives (FDRs). Consequently, questions arise regarding the prioritization of screening among FDRs especially in Asian populations.

Purpose
To investigate prevalence and proportion of FDRs of DCM patients presenting with DCM.

Methods
Patients with DCM and their FDRs who underwent genetic counseling between April 2017 and March 2023 at a single tertiary center were retrospectively enrolled. The study collected baseline demographics and conducted sequential echocardiograms, along with genetic cascade sequencing for 36 genes clinically relevant to DCM. A positive DCM phenotype in FDRs was determined based on the presence of a decreased left ventricular ejection fraction (LVEF) with left ventricular enlargement, with a full phenotype containing both criteria and a partial phenotype containing either of them.

Results
A total of 122 probands (median age 59 years) and 241 FDRs (median age 43 years) participated in the study. Out of 72 FDRs (29.9%) with P/LP proband variants, only 18.6% of FDRs showed a positive DCM-phenotype. Overall, 29 individuals (15.5%) exhibited a positive DCM-phenotype, with 2.7% displaying a full DCM-phenotype and 12.8% displaying a partial DCM-phenotype. Among them, 69% exhibited heart failure (HF) with preserved EF, 20.7% had HF with mildly reduced EF, and 10.3% had HF with reduced EF. Siblings tended to be older compared to offspring (52.1 years vs. 35.5 years), aligning with the tendency shown in the more fulminant manifestation of the positive phenotype. Accordingly, a higher prevalence was observed among siblings (n=4, 80%) with a full phenotype and in those with a partial phenotype.

Conclusion
This study demonstrated higher prevalence of phenotype-positive DCM among siblings of probands. Given disease’s manifestation in adulthood, it is essential to prioritize the screening of all FDRs with emphasis on the siblings.