bluuebunny/crossref_metadata_2025_split huggingface dataset:
The effect of the age at the time of targeting a lead implantation on the difficulty with the transvenous lead extraction technique
Authors: Yamada T 
Published: October 2024

Abstract

Background
In transvenous lead removal procedures, the number of years since the lead implantation is an indicator of procedural difficulty and complications. However, even with the same number of years since the lead implantation, we considered the possibility that a younger age at the time of the implantation (AoI) would increase the difficulty of the procedure.

Objective
To elucidate the procedural difficulty in the transvenous lead extraction procedure according to the age at the time of targeting the lead implantation.

Method
A total of 471 consecutive transvenous lead extraction cases were analyzed. The patient AoI of the oldest lead in extraction procedure cases was divided into two groups: those younger than 60 years (implant age &lt;60 yrs old: AoI&lt;60) and those older than 60 years (implant age ≧60 yrs old: AoI≧60). The analysis was conducted by the number of years since the lead implantation (&lt;10 years: group A, 10 to 20 years: group B, and &gt;20 years: group C).

Results
The number of AoI&lt;60 and AoI≧60 patients were 60 and 254 (Group A), 51 and 56 (Group B), and 41 and 9 (Group C). The patient age significantly differed among the groups between an AoI&lt;60 and AoI≧60 (group A: 51.7 vs. 77.1; P&lt;0.001, group B: 61.6 vs. 83.1; P&lt;0.001, group C: 71.2 vs. 88; P&lt;0.001). But the oldest dwell time (years) was similar for all groups (group A: 4.6 vs. 4.2; P=0.324, group B: 14.2 vs. 13.5; P=0.148, and group C: 25.7 vs. 22.6; P=0.097). The complete removal rate (group A: 97.7% vs. 98.4%; P=0.722, group B: 90.4% vs. 93.3%; P=0.567, and group C: 78.05 vs. 90.95; P=0.337) and major complication-free rate (group A: 98.8% vs. 100%; P=0.391, group B: 96.2% vs. 100%; P=0.125, and group C: 90.2% vs. 100%; P=0.281) were not statistically significant in all groups but were higher for an AoI≧60. An AoI&lt;60 resulted in a longer procedure time (group A: 78.4 min. vs. 65.3 min.; P=0.006, group B: 96.0 min. vs. 72.3 min.; P=0.002, and group C: 100.9 min. vs. 94.8 min.; P=0.709), longer fluoroscopy time (group A: 12.0 min. vs. 10.2 min.; P=0.247, group B: 19.2 min. vs. 11.6 min.; P=0.017, and group C: 22.2 min. vs. 16.0 min.; P=0.008), and higher number of laser pulses (group A: 779.6 vs. 433.7; P=0.002, group B: 2089.6 vs. 1032.9; P=0.017, and group C: 1509.3 vs. 831.5; P=0.201) in all groups.

Conclusion
This study suggested that the difficulty of transvenous lead extraction procedures may increase with a younger AoI, even if the lead dwelling time is the same.
Extraction of leadless and tranvenous pacemakers: occurrence, causes and complications from a national US database
Authors: Leshem-Rubinow E , Poliner I , Kazatsker M , Roguin A , Bareli M , Margolis G 
Published: October 2024

Abstract

Background
Leadless pacemakers are usually implanted as second line treatment in patients with increased risk for infection, difficult or obstructed vascular access, and other causes preventing an implantation of a traditional pacemaker. Data regarding the occurrence and need for leadless pacemaker extraction (LLPE) are currently absent and have not been compared to outcomes of transvenous pacemaker extraction (TLE). Moreover, leadless pacemaker implantation during TLE for active infection in being advocated without backing data. We aimed to assess the rate, causes and complications of device extraction in a large US national database.

Methods
Patients undergoing LLPE and TLE in the USA between 2016 and 2019 were identified from the National Inpatient Sample (NIS) database using ICD-10 codes. Clinical and sociodemographic data, in-hospital complications, outcomes and mortality were collected. Baseline characteristics and outcomes were compared between patients undergoing TLE and LLPE. Multivariate logistic regression identified predictors of in-hospital complications.

Results
An estimated total of 55,235 patients underwent an extraction procedure during the study period. 54,050 (97.8%) patients underwent TLE and 1,185 (2.1%) underwent LLPE. Patients who underwent LLPE were older, more likely females and had a higher comorbidity rate (Charlson-Deyo-Comorbidity-Index; 46% vs 39%, p&lt;0.001). Etiology for LLPE was identified and reported only in 25.7% of cases, however infection causing extraction occurred in 11.4% of LLPE cases and 8% had LLPE due to device dysfunction. Main etiologies for TLE were infections (40.9%) and lead dysfunction (29.4%). In comparison to TLE, LLPE resulted in higher in-hospital mortality (7.2% vs. 3%, p&lt;0.001) and vascular complications (2.5% vs. 1.0%, p&lt;0.001). Multivariable analysis confirmed that LLPE was associated with more than double the risk of in-hospital mortality.

Conclusion
Extraction of leadless pacemakers due to infection is not rare. Patients undergoing LLPE have higher prevalence of vascular complications and in-hospital mortality in a US nationwide, all-comer registry.
Report of cardiac electronic device implant complications over a 7-year study period
Authors: Biniam B , Aydin A , Sadek M , Klein A , Nery P , Nair G , Davis D , Redpath C , Hansom S , Ramirez D , Green M , Birnie D , Gill D , Asif M , Golian M 
Published: October 2024

Abstract

Background
The global placement of cardiac implantable electronic devices (CIEDs) is on the rise. Complications linked to device implantation present a substantial burden on healthcare systems and patients alike. It is imperative to comprehend the complication rates associated with CIED procedures, enabling informed decision-making and strategic planning for patients, thereby enhancing the overall quality of care.

Purpose
We sought to determine post CIED implantation complication rates and provide operator specific complication data for quality assurance at our institution.

Methods
A comprehensive audit of all procedures completed between April 2016 to March 2023 by 14 high volume operators at a single academic center was completed. Complications and device data were extracted using electronic medical records. Complications evaluated include pneumothorax, infections, hematomas, venous thrombosis, lead perforation, and dislodgement using standardized definitions.

Results
During the 7-year period, a total of 9,467 procedures were completed. Among the cohort, 62% were male, with an average age of 74.6 ± 15.2 years. The procedural breakdown comprised 60% pacemakers, 19% ICDs, 16% CRTs and 3% ILRs. A total of 11,616 leads were implanted (3,644 RA leads and 1,110 LV leads). The overall complication rate was 3.1% (n=316): device pocket infection 0.68%, superficial infection 0.19%, lead dislodgement 0.53%, lead perforation 0.24%, pericardial effusion 0.1%, pneumothorax 0.15%, pocket hematoma 0.83%, DVT 0.36%, and hemothorax 0.02%. Complication rates per operator are shown in Figure-1.

Conclusion
Our findings indicate that the overall complication rates for CIED implants are lower than previously reported rates, and there is no significant difference between operators in overall rates of complication. This observation can be attributed to operator experience, advancements in peri-operative care and guideline-directed post-operative protocols. However, notable variations exist among operators in rates of pocket infection. The ongoing monitoring of CIED complications as a quality indicator remains a crucial benchmark, meriting annual assessments for ongoing evaluation.
Proteomic biomarkers and biological mechanisms associated with atrial fibrillation in heart failure patients
Authors: Petersen T B , Loncq De Jong M , Chin J F , Suthahar N , Akkerhuis K M , Umans V A , De Boer R A , Van Dalen B M , Brugts J J , Asselbergs F W , Boersma E , Rizopoulos D , Yap S C , Kardys I 
Published: October 2024

Abstract

Background
Atrial fibrillation (AF) and heart failure (HF) are intertwined conditions with high mortality rates and large impact on quality of life, and their coexistence is increasingly prevalent. Both conditions influence each other’s development and progression, and share many risk-factors—such as hypertension, obesity, diabetes mellitus and ischaemic heart disease. Moreover, their combined presence further increases the risk of hospitalization and mortality. The biological mechanisms at play in HF patients with AF may therefore differ from those in HF patients without AF.

Purpose
We aimed to describe the differences in pathophysiological pathways in HF patients with versus without AF, by identifying biomarkers associated with AF from a panel of 4210 circulating proteins and subsequently examining biological mechanisms related to these biomarkers.

Methods
We examined 377 ambulant HF patients with reduced ejection fraction from a longitudinal cohort study. We measured 4210 circulating proteins in baseline blood samples using an aptamer-based multiplex proteomic approach. Associations between AF (known AF history or AF on the baseline ECG) and the proteins were assessed using linear regression models adjusted for age, sex, kidney function and duration of HF at baseline. Associations of proteins significantly related to AF, with biological processes, were assessed using network-based clustering and subsequent enrichment analysis.

Results
The median [25th, 75th percentile] age was 64 [55, 72], 73% [274/377] were male, 28% [104/375] had NYHA-class III or IV, and 37% [139/377] had AF (either AF history: 36% [137/377] or AF on baseline ECG: 8% [30/374]). We found 71 proteins significantly associated with AF (FDR&lt;0.05), including well-studied (e.g. troponin T, IGFBP7, MFAP4, BMP10, angiopoietin 2) and lesser studied (e.g. olfactomedin−like protein 3, keratocan, basigin) proteins in the AF domain. Our pathway analysis revealed clusters of proteins related to various underlying mechanisms, such as axon guidance, elastic fibre assembly, macrophage derived foam cell differentiation, ether lipid metabolism and amyloid-beta binding. Overviews of the significantly associated proteins and related biological mechanisms are provided in Figures 1 and 2.

Conclusion
HF patients with AF have distinct proteomic profiles and these differences are related to various biological mechanisms, many of which can be associated with atrial remodelling. This study provides an overview of the biological mechanisms behind AF in HF, confirms prior findings regarding AF-related proteins, and could guide future research in novel treatment targets and HF-AF management.Figure 1:Proteins associated with AFFigure 2:Biological mechanisms
Gene-echocardiography: unmasking the covert role of fatty acid metabolism gene mutations in adult cardiomyopathy
Authors: Zhou N 
Published: October 2024

Abstract

Background
Although the role of fatty acid metabolic deficiencies in cardiomyopathy is established, the precise identity of causative genes and their respective phenotypes in adult cardiomyopathy remains unclear.

Methods
We implemented a combination of echocardiography and whole exome sequencing in clinically diagnosed cardiomyopathy patients to uncover this relationship. This involved recording cardiac phenotypes, identifying genes associated with disrupted fatty acid metabolism, and subsequently followed up with these patients.

Results
Out of 802 cardiomyopathy patients, 27 exhibited mutations in genes tied to fatty acid metabolism. Specifically, 16 patients demonstrated a hypertrophic cardiomyopathy (HCM) phenotype, and 11 showed a dilated cardiomyopathy (DCM) phenotype. The implicated genes were SLC22A5 (n=7), ACADVL (n=6), ACADS (n=4), ACADM (n=3), SLC25A20 (n=3), ACADL (n=2), HADH (n=1), and AGK (n=1), with a higher prevalence in males. Among these, the SLC22A5 mutation was predominant and correlated with HCM phenotype. Notably, compound mutations were frequently observed (16/27), leading to earlier disease onset and diminished aortic sinus dimension. Further investigation showed that smaller aortic sinus dimensions resulted from abnormal left ventricular myocardial work. HCM phenotype mutation carriers showed more consistent left ventricular hypertrophy and a higher probability of right ventricular hypertrophy, while DCM phenotype mutation carriers exhibited impaired contractile function across all left ventricle segments. After a 24-month follow-up, the DCM phenotype group demonstrated higher cardiovascular risk, including two fatalities.

Conclusion
Our investigation highlights the significant prevalence of mutations related to abnormal fatty acid metabolism in adult cardiomyopathy patients, underscoring the utility of a gene-echocardiography approach for diagnosis.
Sex differences in RNA transcripts in dilated cardiomyopathy
Authors: Ljungman C , Jamialahmadi O , Bollano E , Anderson B , Romeo S , Bergh N 
Published: October 2024

Abstract

Introduction
Dilated cardiomyopathy (DCM) is the most common cardiomyopathy and a major cause of heart failure. Differences in clinical presentation and phenotype exist in men and women but the reason for this is not clear. The analysis of the RNA transcripts (mRNA sequencing) offers an opportunity to provide a link between the genome, the proteome, and the phenotype. The aim of this study was to explore sex differences using mRNA sequencing in patients with DCM.

Method
Our database, an observational prospective cohort study, includes patients referred for suspected cardiomyopathy. The database includes data on patients’ characteristics, symptoms, diagnostic procedures, treatments, cardiac devices, and outcome. Endomyocardial biopsy from the right ventricle was collected and total RNA, including miRNA and other small RNA, was isolated. RNA sequencing and library preparation was performed. Following quality check, reads were aligned to GRCh38 reference genome by STAR (v2.7.10a). Sex-specific differential expression analysis between individuals diagnosed with DCM (cases) versus non-confirmed cardiomyopathy (controls) was performed using DESeq2 (v.1.38.3) adjusting for age, RNA integrity number and systolic blood pressure. After controlling for multiple testing using the Benjamini-Hochberg method, genes with a corrected P-value &lt; 0.05 were considered as being differentially expressed. Gene-set enrichment analysis on differentially expressed genes was performed via Enrichr tool using Descartes cell types and tissues, KEGG biological pathways, DisGeNET, and Gene Ontology Biological Processes (GOBP).

Results
Patients´characteristics in women and men with DCM is presented in table 1. There was no difference in outcome in men and women (data not shown). Differential expression analyses with transcriptomic data comparing DCM (n=43) versus controls (n=22) stratified by sex (DCM n= 9, (20.9%) women and controls n=7, (30.4%) women) was performed. There was no overlap between differentially expressed genes between sexes (Figure 1). In men gene set enrichment analyses showed that differentially expressed genes were related to pathways involved in dilated and hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy (KEGG). Interestingly, these analyses revealed an enrichment of genes related to platelet biology, namely precursors (Descartes), activation (GOBP, KEGG) and platelet disorder (DisGeNET). In women, HLA-DQB1 was more expressed in DCM. HLA-DQB1 is associated with celiac disease, narcolepsy, and type 1 diabetes. Consistently, the enrichment analyses showed an enrichment of genes involved in autoimmune diseases (DisGeNET).

Conclusion
Women and men with DCM exhibit differently activated RNA transcripts although no difference in phenotype was observed. This may indicate that although DCM can be caused by similar factors in women and men the transcriptome is differently activated which warrants further investigation.Table 1.
Diagnosis of heart failure with preserved ejection fraction based on exercise stress echocardiography in real-world practice
Authors: Tani Y , Reddy Y R , Verbrugge F V , Yang J Y , Negishi K N , Harada T H , Saito Y S , Kagami K K , Yuasa N Y , Murakami F M , Sorimachi H S , Kato T K , Wada N W , Ishii H I , Obokata M O 
Published: October 2024

Abstract

Aims
The diagnostic difficulty of heart failure with preserved ejection fraction (HFpEF) is related to the fact that many patients develop abnormal hemodynamics only during exercise. Exercise stress echocardiography is a first-line test to unmask such abnormalities, but exercise protocols and diagnostic criteria have not been established. It remains unclear how cardiologists diagnose HFpEF by exercise echocardiography in real-world practice.

Methods and Results
An international web-based survey was performed on 87 cardiologists, 59% of whom had ≥ 6 years of experience with exercise echocardiography. A retrospective cohort of 652 dyspneic patients who underwent exercise echocardiography was used to determine the impact of different diagnostic criteria on the proportion of HFpEF diagnosis. The most commonly used exercise echocardiography criterion for the HFpEF diagnosis was the HFA-PEFF algorithm (48%), followed by the ASE/EACVI criteria (24%) and some combinations of multiple parameters (22%). A retrospective study found that the proportion of HFpEF diagnosis varied substantially between the criteria used: 20.1% for the ASE/EACVI criteria and 44.3% for the HFA-PEFF algorithm. A survey demonstrated that 54% of the participating cardiologists would initiate sodium-glucose co-transporter 2 inhibitors based on exercise echocardiography results.

Conclusion
In real-world practice, exercise echocardiography criteria for HFpEF diagnosis vary among cardiologists. While many cardiologists consider initiating pharmacological treatment on exercise echocardiography results, the frequency of HFpEF diagnosis varies substantially depending on the diagnostic criteria used. The lack of universal diagnostic criteria may limit the delivery of evidence-based treatment to patients with HFpEF.
Echocardiographic predictors of cardiovascular outcome in heart failure with preserved ejection fraction
Authors: Wang N , Rueter P , Hibbert T , Ng M , Chandramohan S , Osullivan J , Kaye D , Lal S 
Published: October 2024

Abstract

Background
The optimal echocardiographic predictors of cardiovascular outcome in heart failure with presereved ejection fraction (HFpEF) are unknown.

Purpose
We aimed to identify independent echocardiographic predictors of cardiovascular outcome in patients with HFpEF.

Methods
Systematic literature search of three electronic databases was conducted from date of inception until November 2022. Hazard ratios (HRs) and their 95% confidence intervals (CIs) for echocardiographic variables from multivariate prediction models for the composite primary endpoint of cardiovascular death and heart failure (HF) hospitalization were pooled using a random effects meta-analysis. Specific subgroup analyses were conducted for studies that enrolled patients with acute versus chronic HF, and for those studies that included E/e’, pulmonary artery systolic pressure (PASP), renal function, natriuretic peptides and diuretic use in multivariate models.

Results
Forty-six studies totalling 20,056 patients with HFpEF were included. Three echocardiographic parameters emerged as independent predictors in all subgroup analyses: Decreased left ventricular (LV) global longitudinal strain (HR 1.24, 95% CI 1.10-1.39 per 5% decrease), decreased left atrial (LA) reservoir strain (HR 1.30, 95% CI 1.13-1.1.50 per 5% decrease) and lower tricuspid annular plane systolic excursion (TAPSE) to PASP ratio (HR 1.17, 95% CI 1.07-1.25) per 0.1 unit decrease). Other independent echocardiographic predictors of the primary endpoint were a higher E/e’, moderate to severe tricuspid regurgitation, LV mass index and LA ejection fraction, although these variables were less robust.

Conclusion
Impaired LV global longitudinal strain, lower LA reservoir strain and lower TAPSE/PASP ratio predict cardiovascular death and HF hospitalization in HFpEF and are independent of filling pressures, clinical characteristics and natriuretic peptides. These echocardiographic parameters reflect key functional changes in HFpEF, and should be incorporated in future prospective risk prediction models.
Cardiovascular risks of PD1 inhibitor therapy in cancer: impact of prior ischemic events on heart failure - a retrospective cohort study
Authors: Drobni Z , Gergely T , Zlotoff D , Gilman H K , Gong J , Wu J , Ghamari A , Merkely B , Reynolds K , Varga Z , Neilan T 
Published: October 2024

Abstract

Introduction
Immune checkpoint inhibitors (ICIs) have transformed cancer therapy, but concerns remain about their cardiac risks. Limited recent basic evidence suggests a possible link between ICIs that target PD1 and adverse cardiac events such as heart failure.

Purpose
This study explores the connection between PD1 inhibitor therapy and incident heart failure in cancer patients.

Methods
In our retrospective study at a tertiary medical center, 1,671 cancer patients receiving PD1 inhibitors were analyzed. Individuals with a history of heart failure, who developed myocarditis on PD-1, or had missing data were excluded. Data from pharmacy records and the Research Patient Data Registry provided clinical and ICI-related details. Cases were defined as patients who developed incident heart failure after ICI started. Controls were patients who did not develop incident heart failure after ICI start. Sensitivity analyses, including propensity score matching and comparison with non-ICI-treated cancer patients, ensured result robustness. Multivariate logistic regressions were performed.

Results
Among 1,671 ICI treated patients, 109 (6.5%) developed heart failure without evidence of myocarditis over a median follow-up of 332.0 days. In both the full cohort and the 3:1 matched cohort (n=380), multivariate logistic regression showed increased odds of incident heart failure in patients with prior ischemic cardiac events: 2.34 (95%CI 1.26-4.16, p=0.005) and 2.11 (95%CI 1.05-4.2, p=0.033) respectively. Among the non-ICI treated cancer patients, multivariate logistic regression found no association between prior ischemic events and incident heart failure (1.23, 95%CI 0.53-2.63, p=0.6), but hypertension showed an association (1.74, 95%CI 1.07-2.87, p=0.027).

Conclusion
This study emphasizes vigilance for cardiovascular complications in PD1 inhibitor-treated cancer patients. The incidence of heart failure was 6.5% over a follow-up period of less than 1 year. Prior ischemic events correlate with increased heart failure risk, suggesting a need for nuanced patient management. Understanding ICIs' cardiovascular safety is crucial for risk assessment, treatment optimization, and patient well-being.
Beyond resting measurements: exercise pulse pressure and its association with heart failure hospitalization
Authors: Fu Y , Huang W M , Sung S H 
Published: October 2024

Abstract

Background
Pulse pressure (PP), the difference between systolic and diastolic blood pressure, is a known predictor of heart failure (HF). While high resting PP has been linked to increased HF risk, the implications of exercise-induced PP changes remain less understood. This study investigates the contrasting roles of exercise PP in predicting hospitalization for heart failure (hHF).

Methods
We conducted a retrospective analysis of adults referred for treadmill exercise testing between 2003 and 2012. ΔMaximal BP referred to the BP change from rest to peak exercise. Cox proportional hazards models adjusted for demographic and clinical variables were used to assess the predictive value of PP changes for hHF.

Results
Among 15,249 participants, 117 (0.7%) were hospitalized for HF over a median follow-up of 112 months. Higher resting PP was significantly associated with an increased risk of hHF, whereas increased Exercise PP was inversely related to hHF risk independently (adjusted HR: 0.76, 95% CI: 0.67-0.86, P&lt;0.001).

Conclusions
Resting PP and Exercise PP exhibit opposite effects on the risk of heart failure hospitalization. These findings suggest the importance of considering both resting and exercise-induced PP changes in the assessment and management of heart failure risk.