bluuebunny/crossref_metadata_2025_split huggingface dataset:
Clinical characteristics and outcomes of patients with takotsubo syndrome and dynamic left ventricular outflow tract obstruction
Authors: Di Vece D , Bellino M , Silverio A , Migliarino S , Bossone E , Scudiero F , Novo G , Cameli M , Cristiano M , Aleksova A , Vecchione C , Galasso G , Parodi G , Sinagra G , Citro R 
Published: October 2024

Abstract

Background
Left ventricular outflow tract obstruction (LVOTO) is recognized as a serious complication of Takotsubo syndrome (TTS). However, its impact on patient prognosis remains insufficiently investigated.

Purpose
This study aimed to assess clinical characteristics and short- and long-term outcomes of patients with TTS complicated by LVOTO.

Methods
Patients with TTS were enrolled from the Takotsubo Italian Network (TIN). The primary outcome was the composite of acute heart failure, cardiogenic shock, and mortality during hospitalization. Secondary outcomes included the single components of the primary outcome and the occurrence of death or TTS recurrence during follow-up.

Results
Overall, 881 patients were included in the study [median age 72.0 (63.0–78.0) years; 91.3% female], with LVOTO detected in 59 patients (6.7%). Low diastolic blood pressure, ST-segment elevation, and moderate-to-severe mitral regurgitation were independently associated with occurrence of LVOTO. Propensity score weighting regression analysis revealed a significant higher risk of the primary outcome (OR, 2.99; 95% CI, 2.22–4.02), acute heart failure (OR, 2.19; 95% CI, 1.59–3.02), cardiogenic shock (OR, 4.56; 95% CI, 3.07–6.78), and in-hospital mortality (OR, 2.42; 95% CI, 1.13–5.21) in patients with TTS complicated by LVOTO. No significant association between LVOTO and long-term mortality or TTS recurrence was observed during follow-up.

Conclusions
In this real-world evidence study, LVOTO was detected in about 7% of TTS patients and was associated with a significantly higher risk of adverse events during hospitalization, including mortality. Early detection of LVOTO can aid in prognostic assessment and guide therapeutic management in patients with TTS.
Long-term outcomes in hospitalized heart failure patients in China: results from the China National Heart Failure (CN-HF) registry study
Authors: Cui X T , Jin X J , Zhou J , Xu Y M , Wang Y Y , Sun A J , Fu M , Hu K , Zhou J M , Ge J B 
Published: October 2024

Abstract

Background
There is a paucity of data on the long-term outcomes of heart failure (HF) patients in China. We aimed to investigate the incidence of cardiovascular (CV) death or rehospitalization due to worsening HF (WHF) and other outcomes among different subtypes of patients with chronic HF in China.

Methods
Data from the China National HF registry (CN-HF) during the period 1 February 2013–31 October 2015 were analyzed. Patients were categorized into three groups based on their left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF, LVEF≤40%), HF with mildly reduced ejection fraction (HFmrEF, LVEF 41%–49%), and HF with preserved ejection fraction (HFpEF, LVEF≥50%). Rates and risk of CV death or HF rehospitalization and other outcomes including all-cause mortality in each group were calculated and compared.

Results
In total 7171 patients (mean age 69.6 years, 59.5% male) with HF were enrolled across 45 centers in China. At discharge, ACEIs/ARBs, β-blockers and MRA were prescribed in 57.3%, 50.8% and 54.5% HF patients totally. The overall incidence of the primary outcome (CV death or HF rehospitalization) was 8.9%, 16.1%, and 23.5% at 6, 12, and 24 months post-discharge, respectively. Significantly higher rates of the primary outcome, all-cause mortality, and HF re-hospitalization were observed in patients with HFrEF and HFmrEF compared with those with HFpEF at 6, 12, and 24 months (P &lt; 0.05). The incidence of CV death was similar across all LVEF subgroups.

Conclusions
Compared to patients with HFpEF, incidence of death or rehospitalization were higher among patients with HFrEF or HFmrEF in China. Optimal follow-up and management of HF both inside and outside of the hospital should be highlighted and put into practice.Primary outcome according to LVEFAll-cause death and rehospitalization
Anthropometric measures and long-term mortality in heart failure with reduced ejection: debunking the obesity paradox
Authors: Butt J , Thune J J , Nielsen J C , Gustafsson F , Bruun N E , Eiskjaer H , Brandes A , Hassager C , Svendsen J H , Torp-Pedersen C , Schou M , Pehrson S , Packer M , Mcmurray J J V , Koeber L 
Published: October 2024

Abstract

Background
In patients with heart failure (HF), an "obesity-survival paradox" has been reported. Although body mass index (BMI) is the most commonly used anthropometric measure to assess adiposity, alternative indices such as the waist-to-height ratio may better reflect the location and amount of ectopic fat as well as the weight of the skeleton.

Purpose
To examine and compare the prognostic value of several alternative anthropometric measures with that of BMI in patients with non-ischemic HF with reduced ejection fraction (HFrEF) enrolled in the DANISH trial. Patients were eligible if they had non-ischemic HFEF, a left ventricular ejection fraction of &lt;35%, New York Heart Association functional class II-III (IV if cardiac resynchronization therapy was planned), and elevated natriuretic peptides. The outcomes of interest were all-cause mortality and cardiovascular death. The association between anthropometric measures and all-cause death was examined with Cox regression models, adjusted for prognostic variables, including natriuretic peptides.

Results
Among 1,116 patients with non-ischemic HFrEF, there was no evidence for a BMI-related "obesity-survival paradox" during a median follow-up of 9.5 years (25th-75th percentile, 7.9-10.9 years). Indeed, compared to patients with a BMI 18.5-24.9 kg/m2 (N=363), those with a BMI &gt;35 kg/m2 (N=91) had a significantly higher risk of all-cause death (HR 1.78 [95% CI 1.28-2.48]). Greater waist-to-height ratio (as an exemplar of indices not incorporating weight) was also associated with a higher risk of all-cause death, with a HR of 2.11 (95% CI, 1.53-2.92) for the highest quintile (N=205) compared with the lowest quintile (N=196). In the minimally adjusted restricted cubic spline models, the association between adiposity and all-cause death was more apparent for waist-to-height ratio than for BMI. A similar pattern was seen for cardiovascular death (Figure).

Conclusion
In patients with HFrEF, there was no evidence for an "obesity-survival paradox". Indeed, there was a clear association between adiposity and higher long-term mortality, which appeared to be stronger for waist-to-height ratio than for BMI. There is a need to test the potential benefits of intentional weight loss in patients with HFrEF and obesity.
Blood plasma metabolites and heart failure risk: insights from Mendelian randomization analysis
Authors: Ma Z , Frey N , Rangrez A Y 
Published: October 2024

Abstract

Background
Heart failure remains a leading cause of mortality and disability worldwide. Blood plasma metabolites play a crucial role in influencing heart failure, yet they are subject to numerous confounding factors. Mendelian randomization analysis provides a powerful tool for assessing causal relationships between them.

Methods
We conducted a Mendelian randomization analysis using a meta-analysis comprising 115,150 heart failure cases (155,331 controls) and 1400 serum metabolites. Various methods including Inverse variance weighting (IVW), MR Egger, Weighted median, and Weighted mode were employed to estimate causal effects. Sensitivity analyses were conducted using Cochran’s Q test, MR Steiger test, leave-one-out analyses, funnel plot, and MR-PRESSO.

Results
Following rigorous selection, among the 1400 blood plasma metabolites, 71 metabolites including Sphingomyelin, Myristate, AMP to methionine ratio showed significant associations with increased risk of heart failure. Additionally, 40 metabolites including Glycine, octadecenedioylcarnitine (C18:1-DC), 1-palmitoyl-2-dihomo-linolenoyl-GPC (16:0/20:3n3 or 6) exhibited significant associations with decreased risk of heart failure.

Conclusion
Identified blood plasma metabolites provide crucial insights into screening and prevention strategies for heart failure. Further validation is warranted through animal models and large-scale cohorts.
Validation of a hand-held ultrasound device in the evaluation of aortic stenosis
Authors: Zubiaur Zamacola J , Margarida De Castro A , Perez Barquin R , Lozano Gonzalez M , Gutierrez Ruiz N , Alarcos H , Gonzalez Vilchez F , Ruisanchez Villar C , Serrano D , Cuesta Cosgaya J M , Coroas C , Munoz Prejigueiro L , Abia L , De La Torre J M , Vazquez De Prada J A 
Published: October 2024

Abstract

Introduction
Hand-held Ultrasound devices (HHUD) are increasingly used in routine clinical practice, although until recently they did not have continuous Doppler. There is no evidence on the usefulness of an HHUD for the assessment of aortic stenosis (AS) in real life.

Objective
To validate the use of a new HHUD device in a real-life scenario.

Material and methods
Observational, single-center and prospective study, including patients diagnosed with AS with a previous standard echocardiography. Patients were randomly recruited from a tertiary cardiac imaging laboratory. Immediately after the reference echocardiography performed by an imaging expert, a Cardiology trainee with ASE level II repeated the study blindly with an HHUD. Agreement between the two tests was evaluated by measuring the mean aortic valve gradient (mAG). An intraclass correlation coefficient (ICC) test, linear regression, and Bland-Altman test were performed to compare the two methods.

Results
101 patients were recruited. The reference test calculated a mAG of 29 mmHg (19.8 - 42.2) versus a mAG of 27.2 mmHg (16.2 - 43.9) in HHUD. The statistical analysis showed a good correlation between both tests (ICC: 0.87 (95% CI: 0.79 -0.94) and r=0.89 (95% CI: 0.85-0.94) (Figure). The Bland-Altman test showed a non-significant underestimation (1.61 ± 0.9 mmHg; p= 0.09). The HHUD classified 29 cases as severe or major AS compared to 31 in the reference test (kappa= 0.81; 95% CI: 0.68 - 0.94). The HHUD showed an excellent agreement for classification of AS in at least severe AS grade. The kappa analysis had a value of 0.81 (95% CI 0.68 – 0.94) with a global agreement of 92.1%. The positive predictive value was 89.6%. The negative predictive value was 93.1%. Sensitivity and specificity were 83.8% and 95.7%. The rest of the variables evaluated showed poorer agreement. In those patients with obesity, worse acoustic window, atrial fibrillation and critical AS, the agreement was worse.

Conclusions
The new HHUD evaluated by an operator with limited experience showed good agreement with the reference echocardiographic device in determining the mean aortic gradient.Central picture
Prognostic value of alveolar surfactant type-B in acute heart failure: a long-term comparative analysis vs NT-proBNP
Authors: Bonazzi C , Bursi F , Furlotti N , Nemola G , Novello G , Martin D , Caretti A , Guazzi M 
Published: October 2024

Abstract

Background
In heart failure (HF) biomarkers are an integral component of prognostic assessment. Natriuretic peptides are the gold standard, but they do not directly reflect lung vascular injury. Surfactant type B (Surf-B) is released by type 2 alveolar cells under pressure induced trauma, with few reports just addressing its plasmatic levels in stable chronic HF (CHF). Information on acute HF (AHF) is lacking.

Purpose
To clarify the prognostic value of Surf-B changes vs NT-proBNP levels after decongestion therapy and to compare their prognostic ability at 1-year follow-up.

Methods
Patients with acute pulmonary edema (APE) underwent a combined evaluation of Surf-B and NT-proBNP serum levels with quantification of B-lines at hospital admission (time 0), discharge (time 1) and at 1 year (time 2).

Results
54 patients (mean age 72.1 ± 11 years; mean LVEF 36% ± 13%; 65% men) were enrolled. At time 1, the average Surf-B, NT-proBNP and B-lines were significantly reduced compared to time 0 (p&lt;0.0001). No correlation between Surf-B and NT-proBNP was observed either at time 0 (r=-0.21; p=0.12) or at time 1 (r=0.05; p=0.71).
Despite the significant decrease in Surf-B levels from time 0 to time 1, 18.5% of patients behaved as non-responders exhibiting no changes in Surf-B; conversely, only 5.5% did not show significant reduction in NT-proBNP, despite significant decongestion.
38 patients were followed up to time 2: of these, 13 (34%) reached the composite endpoint of death or hospitalization for HF. Surf-B measured at time 1 was a strong predictor of adverse outcome. Patients with Surf-B above median at discharge displayed a worse survival-free from HF hospitalization compared to the remainders (Log rank p=0.012) (Figure). Also, patients with Surf-B above median at discharge had a more than 4-fold increased risk of the composite endpoint (HR 4.5, 95%CI 1.4-20.2, p=0.023). Conversely, NT-proBNP at discharge was not significantly associated with HF-free survival (Log rank p=0.26) (Figure) and was not a significant predictor of the composite outcome (HR 1.9, 95%CI 0.6-9.3, p=0.25). At ROC analysis, discharge Surf-B levels showed a higher area under the curve (AUC=0.763, p=0.011) than NT-proBNP values (AUC=0.69, p=0.063).

Conclusions
These data suggest that Surf-B, an organ specific biomarker of lung injury, is highly sensitive to the effectiveness of decongestion therapy, outperforming NT-proBNP. Given the high rate of patients who do not improve their Surf-B levels over time, the reparative processes of alveolar break damage may dissociate from mere decongestion and cardiac healing in AHF.Figure:1yr Kaplan-Meier survival curves
Prognostic value of right ventricular-pulmonary arterial coupling indices in patients with moderate to severe mitral stenosis
Authors: Chan M W , Li T , Leow R , Poh K K , Yeo T C , Kong W , Sia C H 
Published: October 2024

Abstract

Background
Right ventricular-pulmonary arterial (RV-PA) coupling represents the relationship of RV contractility and RV afterload. The ability of RV to adapt to changes in RV afterload (i.e. increased pulmonary arterial (PA) loading) has prognostic implications in various cardiovascular diseases such as heart failure and pulmonary arterial hypertension. RV-PA uncoupling occurs when RV contractility cannot match RV afterload, resulting in right heart dysfunction. However, RV-PA coupling has not been investigated in mitral stenosis patients.

Purpose
To evaluate the prognostic significance of various non-invasive RV-PA coupling parameters (TAPSE/PASP and RVFWLS/PASP) in patients with moderate to severe mitral stenosis.

Methods
This was a single-center retrospective study of 237 patients with moderate or severe mitral stenosis enrolled between January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected. RV free wall longitudinal strain (RVFWLS) was subsequently analyzed using TOMTEC software. Echocardiography-derived RV-PA coupling parameters were collected, including TAPSE/PASP and RVFWLS/PASP. The primary endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). RV parameters were analyzed separately to avoid collinearity.

Results
A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%). The median follow-up duration was 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean TAPSE 18.29 ± 5.36 mm and mean RVFWLS was -23.60 ± 7.96 %. In separate multivariable Cox regression models after adjustment for age , sex and mitral stenosis severity, TAPSE/PASP ratio &lt; 0.36mm/mmHg (HR 2.025 , 95% CI 1.395-2.939, p &lt; 0.001 ) and RVFWLS/PASP ratio ≥ - 0.5%/mm Hg (HR 2.031 95% CI 1.404 – 2.938 , p&lt; 0.001) remained independently associated with mortality , heart failure hospitalization and valve intervention.

Conclusion
TAPSE/PASP and RVFWLS/PASP were independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.
Changes in N-terminal pro b-type natriuretic peptide according to SGLT2 inhibitor utilization patterns in patients hospitalized for decompensated heart failure: a prospective cohort study
Authors: Fountoulakis P , Theofilis P , Sagris M , Oikonomou E , Siasos G , Halvatsiotis P , Tsioufis P , Aggeli C , Tsioufis K , Tousoulis D 
Published: October 2024

Abstract

Introduction
Sodium-glucose cotransporter-2 (SGLT2) inhibitors have found success in treating patients with chronic heart failure (HF) across the entire spectrum of left ventricular ejection fraction (EF). Their benefits may also extend to patients with acute HF decompensation, as they may aid effective decongestion.

Purpose
This study aims to present the various patterns in changes of N-terminal pro b-type natriuretic peptide (NT-proBNP) according to SGLT2 inhibitor use in patients hospitalized for acute HF decompensation.

Methods
In this prospective cohort study, we enrolled consecutive patients hospitalized for HF decompensation during a 4-month period in a cardiology department. Prior medical history and cardiovascular risk factors were recorded. The patterns in SGLT2 inhibitor use were noted and patients were classified into three groups; Group 1 (No SGLT2 inhibitor use/Discontinuation), Group 2 (Prior SGLT2 inhibitor use and continuation), and Group 2 (SGLT2i-naïve and initiation). Categorization according to left ventricular (EF) to HF with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) was also performed. Moreover, estimated glomerular filtration rate (eGFR) was used as an estimate of renal function.

Results
In this analysis, 159 patients were included (median age: 79 years old, male sex: 64.8%, median duration of hospitalization: 6 days). In this population, 67.9% of the patients were not receiving a SGLT2 inhibitor on admission. Concerning demographic and clinical variables (Figure 1), there were no major differences in age, sex distribution, history of diabetes mellitus, dyslipidemia, and atrial fibrillation, as well as in renal function. Group 2 patients had a lower prevalence of arterial hypertension compared to Group 3 (36.6% vs. 52.6%, p&lt;0.05). Moving to the changes in NTproBNP (Figure 2), we observed that patients who did not use SGLT2 inhibitors and did not initiate them during hospitalization had negligible changes in NTproBNP, either as an absolute change (Group 1: 506 (8792) pg/ml vs. Group 2: -5610 (9461) pg/ml vs. Group 3: -3602 (4409) pg/ml, p=0.001) or as percentage change (Group 1: -2.1 (63.4) % vs. Group 2: -30.3 (39.0) % vs. Group 3: -38.3 (41.5) %, p=0.001), compared to the rest of the study population who were already taking SGLT2 inhibitors or initiated them during hospitalization.

Conclusion
In this study we found NTproBNP, a widely used biomarker of congestion and prognosis in HF, was significantly reduced in decompensated HF patients receiving SGLT2 inhibitors, with the greatest change being observed in those being treatment-naïve prior to admission. These findings further highlight the role of this drug class even in the acute phase of the disease.Figure 1Figure 2
Prognostic value of left atrial strain in patients with moderate to severe mitral stenosis
Authors: Chan M W , Li T , Leow R , Poh K K , Yeo T C , Kong W , Sia C H 
Published: October 2024

Abstract

Background
Mitral stenosis causes an inflow restriction during diastole and is characterized by an increase in left atrial (LA) pressure with reduced cardiac output. Pressure overload of the LA can lead to atrial fibrosis and remodeling, resulting in a loss of LA reservoir and compliance capacity that can lead to backward load on the pulmonary circulation. To date, there are limited studies evaluating the impact of LA strain on prognosis of mitral stenosis patients.

Purpose
The aim of this study was to assess the prognostic value of LA strain in patients with moderate to severe mitral stenosis using two-dimensional (2D) strain imaging.

Methods
This was a single-center retrospective study, 237 patients with moderate or severe mitral stenosis were enrolled from January 2010 to December 2022. Baseline clinical and echocardiographic parameters were collected, LA strain measurements with reference time point at end diastole for reservoir strain (LASr), conduit strain (LAScd) and contraction strain (LASct) were analyzed using TOMTEC software. The endpoint was a composite outcome of all-cause mortality, heart failure hospitalization and valve intervention (percutaneous transvenous mitral commissurotomy and surgical intervention). All the LA parameters were analyzed separately to avoid collinearity.

Results
A total of 237 patients were included in the study. The patients had a mean age was 66.56 ± 13.61 years-old and were predominantly female (67.9%) with median follow up duration is 4.54 years (IQR 1.44 – 6.44). Mean left ventricular ejection fraction (LVEF) was 56.86 ± 10.51%, mean left atrium volume index (LAVI) was 73.94 ± 55.46 ml/m2, mean for LASr, LAScd and LASct were 11.81 ± 8.89%, -6.19 ± 4.50%, and -5.58 ± 6.05% respectively. LASr with a cut-off &lt; 15.8% was independently associated with the composite outcome of all-cause mortality, heart failure hospitalization and valve intervention on multivariable Cox regression analysis (HR 2.51, 95% CI 1.54 - 4.10, p &lt; 0.001). LAScd, LASct and LA volume index did not demonstrate any significant association with the endpoint.

Conclusion
LASr was independently associated with all-cause mortality, heart failure hospitalization and valve intervention in patients with moderate to severe mitral stenosis.