bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neonatal Heart Regeneration
Authors: Lam Nicholas T. , Sadek Hesham A. 
Published: September 2018

Background:
The adult mammalian heart is incapable of meaningful functional recovery after injury, and thus promoting heart regeneration is 1 of the most important therapeutic targets in cardiovascular medicine. In contrast to the adult mammalian heart, the neonatal mammalian heart is capable of regeneration after various types of injury. Since the first report in 2011, a number of groups have reported their findings on neonatal heart regeneration. The current review provides a comprehensive analysis of heart regeneration studies in neonatal mammals conducted to date, outlines lessons learned, and poses unanswered questions.

Methods:

We performed a PubMed search using the keywords “neonatal” and “heart” and “regeneration.” In addition, we assessed all publications that cited the first neonatal heart regeneration reports: Porrello et al,
Science
, Feb 2011 for apical resection injury; Porrello et al,
PNAS
, Dec 2012 for coronary ligation injury; and Mahmoud et al,
Nature Methods
, Jan 2014 for surgical methodology. Publications were examined for surgical models used, timing of surgery, and postinjury assessment including anatomic, histological, and functional assessment, as well as conclusions drawn.

Results:
We found 30 publications that performed neonatal apical resection, 19 publications that performed neonatal myocardial infarction by coronary artery ligation, and 6 publications that performed cryoinjury using liquid nitrogen–cooled metal probes. Both apical resection and ischemic infarction injury in neonatal mice result in a robust regenerative response, mediated by cardiomyocyte proliferation. On the other hand, several reports have demonstrated that cryoinjury is associated with incomplete heart regeneration in neonatal mice. Not surprisingly, several studies suggest that injury size, as well as surgical and histological techniques, can strongly influence the observed regenerative response and final conclusions. Studies have utilized these neonatal cardiac injury models to identify factors that either inhibit or stimulate heart regeneration.

Conclusions:
Overall, there is consensus that both apical resection and coronary ligation injuries during the first 2 days of life result in heart regeneration in neonatal mammals, whereas cryoinjury was not associated with a similar regenerative response. This regenerative response is mediated by proliferation of preexisting cardiomyocytes, and is modifiable by injury size and surgical technique, as well as metabolic, immunologic, genetic, and environmental factors.
Shock Index Predicts Patient‐Related Clinical Outcomes in Stroke
Authors: Myint Phyo Kyaw , Sheng Shubin , Xian Ying , Matsouaka Roland A. , Reeves Mathew J. , Saver Jeffrey L. , Bhatt Deepak L. , Fonarow Gregg C. , Schwamm Lee H. , Smith Eric E. 
Published: September 2018

Background

The prognostic value of shock index (
SI
), heart rate divided by systolic blood pressure, in stroke for clinical outcomes other than mortality is not well understood.

Methods and Results

We examined the Get With The Guidelines–Stroke (
GWTG
‐Stroke) data to explore the usefulness of
SI
in predicting in‐hospital outcomes in 425 808 acute stroke cases (mean age: 71.0±14.5 years; 48.8% male; 89.7% ischemic stroke and 10.3% intracerebral hemorrhage) admitted between October 2012 and March 2015. Compared with patients with
SI
of 0.5 to 0.7, patients with
SI
>0.7 (13.6% of the sample) had worse outcomes, with adjusted odds ratios of 2.00 (95% confidence interval [
CI
], 1.92–2.08) for in‐hospital mortality, 1.46 (95%
CI
, 1.43–1.49) for longer length of hospital stay >4 days, 1.50 (95%
CI
, 1.47–1.54) for discharge destination other than home, 1.41 (95%
CI
, 1.38–1.45) for inability to ambulate independently at discharge, and 1.52 (95%
CI
, 1.47–1.57) for modified Rankin Scale score of 3 to 6 at discharge. Results were similar when analyses were confined to those with available National Institutes of Health Stroke Scale (NIHSS) or within individual stroke subtypes or when
SI
was additionally included in the models with or without blood pressure components. Every 0.1 increase in
SI
>0.5 was associated with significantly worse outcomes in linear spline models. The addition of
SI
to existing
GWTG
‐Stroke mortality prediction models without
NIHSS
demonstrated modest improvement, but little to no improvement was noted in models with
NIHSS
.

Conclusions

SI
calculated at the point of care may be a useful prognostic indicator to identify those with high risk of poor outcomes in acute stroke, especially in hospitals with limited experience with
NIHSS
assessment.
Bedside Ultrasound Assessment of Jugular Venous Compliance as a Potential Point‐of‐Care Method to Predict Acute Decompensated Heart Failure 30‐Day Readmission
Authors: Simon Marc A. , Schnatz Rick G. , Romeo Jared D. , Pacella John J. 
Published: September 2018

Background

Heart failure is one of the most costly diagnosis‐related groups, largely because of hospital readmissions. Objective assessment of volume status to ensure optimization before hospital discharge could significantly reduce readmissions. We previously demonstrated an ultrasound method of quantifying percentage of cross‐sectional area (
CSA
) change of the right internal jugular vein with Valsalva that reliably estimates central venous pressure.

Methods and Results

Patients admitted with acute decompensated heart failure (
ADHF
) underwent ultrasound measurements of the right internal jugular vein at end‐expiration and during the strain phase of Valsalva to determine a percentage of
CSA
change. An initial subgroup of patients with right heart catheterization and accompanying ultrasound measurements of the right internal jugular vein identified a percentage of
CSA
change predictive of right atrial pressure (
RAP
) ≥12 mm Hg. Images of admitted
ADHF
patients were obtained at admission and discharge for final analysis. Simultaneous right heart catheterization and right internal jugular vein ultrasound measurements demonstrated that a <66%
CSA
change predicted
RAP
≥12 mm Hg (positive predictive value: 87%;
P
<0.05, receiver operating characteristic curve). Elevated admission
RAP
by percentage of
CSA
change normalized by discharge (
P
<0.05), indicating that this test is significantly responsive to therapeutic interventions. Using the cutoff value of 66%
CSA
change, normal
RAP
at discharge had 91% predictive value for patients avoiding 30‐day readmission (
P
<0.05).

Conclusions

This bedside ultrasound technique strongly correlates to invasive
RAP
measurement in
ADHF
patients, identifies restoration of euvolemia, and is predictive of 30‐day
ADHF
readmission. This tool could help guide inpatient
ADHF
treatment and may lead to reduced readmissions.
Fibroblast Growth Factor‐23 and Heart Failure With Reduced Versus Preserved Ejection Fraction: MESA
Authors: Almahmoud Mohamed Faher , Soliman Elsayed Z. , Bertoni Alain G. , Kestenbaum Bryan , Katz Ronit , Lima João A. C. , Ouyang Pamela , Miller P. Elliott , Michos Erin D. , Herrington David M. 
Published: September 2018

Background

Higher fibroblast growth factor‐23 (
FGF
‐23) levels are associated with incident heart failure (
HF
) in MESA (the Multiethnic Study of Atherosclerosis).
FGF
‐23 is also associated with left ventricular hypertrophy. Whether the
FGF
‐23 association with
HF
is similar for heart failure with reduced ejection fraction (
HF
r
EF
) and heart failure with preserved ejection fraction (
HF
p
EF
) is not well established.

Methods and Results

We studied 6542 participants (mean age 62±10 years, 53% women, mean estimated glomerular filtration rate of 81±18 mL/min per 73 m
2
) from MESA who were free of cardiovascular disease at baseline (2000–2002).
HF
events were ascertained by an adjudication committee for a median follow‐up of 12.1 years. We classified
HF
events as
HF
r
EF
(ejection fraction [
EF
] <50%) or
HF
p
EF
[
EF
] ≥50%) at the time of diagnosis. Cox proportional hazard regression was used to compute hazard ratios and 95% confidence intervals for the association between baseline serum
FGF
‐23 and incident
HF
r
EF
and
HF
p
EF
. A total of 134 events were classified as
HF
p
EF
, 151
HF
r
EF
, and 49 unknown
EF
. Following imputation, 149 were classified as
HF
p
EF
, 176
HF
r
EF
, and 291 participants had
HF
(34 participants had
HF
p
EF
then
HF
r
EF
). In the fully adjusted model, higher
FGF
‐23 levels were associated with incident
HF
p
EF
but not with
HF
r
EF
(hazard ratio 1.29, 95% confidence interval, 1.08–1.54) versus (hazard ratio 1.04, 95% confidence interval, 0.84–1.29) for each 20 pg/mL higher serum
FGF
‐23 concentration.

Conclusions

FGF
‐23 association with
HF
is driven by the association with
HF
p
EF
but not with
HF
r
EF
in a population‐based cohort. Further studies are needed to determine the pathological mechanisms mediating this association.
Trastuzumab in Female Breast Cancer Patients With Reduced Left Ventricular Ejection Fraction
Authors: Nowsheen Somaira , Aziz Khaled , Park Jae Yoon , Lerman Amir , Villarraga Hector R. , Ruddy Kathryn Jean , Herrmann Joerg 
Published: September 2018

Background

Trastuzumab is life‐extending therapy for breast cancer patients overexpressing the human epidermal growth factor receptor 2 (
HER
2+), but has known cardiotoxic risk. We sought to determine if trastuzumab can be administered to patients with reduced baseline cardiac function at no higher cardiotoxicity risk than in those with normal cardiac function at baseline.

Methods and Results

We performed a retrospective study of women treated with trastuzumab for human epidermal growth factor receptor 2 breast cancer at Mayo Clinic Rochester between January 1, 2000 and August 31, 2015 with pre‐ and on‐therapy echocardiograms available for review. A left ventricular ejection fraction (LVEF) <53% was considered abnormal, and a ≥10% decline in
LVEF
as evidence of cardiotoxicity based on the criteria of the American Society of Echocardiography. A total of 428 women were identified; 408 had a normal cardiac function (
LVEF
63.4±5%) and 20 had an impaired cardiac function (
LVEF
45.4±7%) before trastuzumab. Seven women (35%) with reduced
LVEF
at baseline had a ≥10% reduction in
LVEF
, compared with 179 (43.9%) of those with normal
LVEF
before trastuzumab initiation (
P
=
NS
). Symptomatic heart failure developed more often in patients with reduced versus normal baseline
LVEF
(25% versus 4.2%,
P
<0.05). After adjusting for patient age and breast cancer disease stage, survival rates over 5 years from time of diagnosis were found to be lower for patients with reduced baseline
LVEF
compared with patients with normal baseline
LVEF
(
P
<0.001); the adjusted proportion of patients surviving at 5 years for those with low
LVEF
at baseline was 79% and for those with normal
LVEF
was 93%.

Conclusions

Women undergoing trastuzumab therapy for breast cancer with impaired baseline cardiac function experience no higher risk of
LVEF
decline, but more frequently develop symptomatic heart failure. While trastuzumab could be considered, these patients should be co‐managed by a cardiologist.
9‐Year Trend in the Management of Acute Heart Failure in Japan: A Report From the National Consortium of Acute Heart Failure Registries
Authors: Shiraishi Yasuyuki , Kohsaka Shun , Sato Naoki , Takano Teruo , Kitai Takeshi , Yoshikawa Tsutomu , Matsue Yuya 
Published: September 2018

Background

Acute heart failure (
AHF
) is a heterogeneous condition, and its characteristics and management patterns differ by region. Furthermore, limited evidence is available on
AHF
outside of Western countries. A project by the National Consortium of Acute Heart Failure Registries was designed to evaluate the trends over time in patient backgrounds, in‐hospital management patterns, and long‐term outcomes of patients with
AHF
over 9 years in Japan.

Methods and Results

Between 2007 and 2015, registry data for patients with
AHF
were collected from 3 large‐scale quality
AHF
registries (
ATTEND
/
WET
‐
HF
/
REALITY
‐
AHF
). Predefined end points were trends over time in age, sex, and clinical outcomes, including short‐ and long‐term mortality and readmission for heart failure. The final data set consisted of 9075 patients with
AHF
. No significant differences in patient backgrounds and laboratory findings (eg, anemia or renal function) were observed, with the exception of patient age; mean age became substantially higher over 9 years (71.6–77.0 years;
P
for trend, <0.001). On the contrary, length of hospital stay became shorter (mean, 26–16 days). These changes were not associated with in‐hospital mortality (4.7–7.5%) or 30‐day heart failure readmission rate (4.8–5.4%), as well as 1‐year mortality and heart failure readmission rate (20.1–23.3% and 23.6–26.2%, respectively).

Conclusions

Length of hospital stay in patients with
AHF
shortened over the 9‐year period despite the increasing age of the patients. However, short‐ and long‐term outcomes do not seem to be affected; continuous efforts to monitor clinical outcomes in patients with
AHF
are needed.
Tako‐Tsubo Cardiomyopathy in Severe Sepsis: Nationwide Trends, Predictors, and Outcomes
Authors: Vallabhajosyula Saraschandra , Deshmukh Abhishek J. , Kashani Kianoush , Prasad Abhiram , Sakhuja Ankit 
Published: September 2018

Background

There are limited data on the presentation of Takotsubo cardiomyopathy (
TTC
) in severe sepsis.

Methods and Results

This was a retrospective cohort study using the National Inpatient Sample database (2007–2013) of all adults with severe sepsis.
TTC
was identified in patients with severe sepsis using previously validated administrative codes. The primary outcome was in‐hospital mortality, and secondary outcomes included resource utilization and discharge disposition. Regression analysis was performed for the entire cohort and a propensity‐matched sample. An exploratory analysis was performed for predictors of
TTC
incidence and mortality in
TTC
. During this 7‐year period, in 7.1‐million hospitalizations for severe sepsis,
TTC
was diagnosed in 10 746 (0.15%) admissions.
TTC
was noted more commonly in whites, females, and among 65‐ to 79‐year‐old individuals.
TTC
was independently associated with lower in‐hospital mortality in severe sepsis (odds ratio, 0.58; 95% confidence interval, 0.51–0.65). This association was more prominent in females (odds ratio, 0.51; 95% confidence interval, 0.44–0.59]) compared with males (odds ratio, 0.69; 95% confidence interval, 0.55–0.85]). Presentation in later years of the study period, middle‐age, female sex, and white race were independent predictors for the diagnosis of
TTC
. Age ≥80 years, black race, greater comorbidity, and multiorgan dysfunction were independently associated with higher in‐hospital mortality among
TTC
admissions.

Conclusions

TTC
is observed with increasing frequency in severe sepsis and was associated with a significantly lower in‐hospital mortality compared with patients without
TTC
. Presentation in later years of the study period, middle age, female sex, and white race were independent predictors for the diagnosis of
TTC
in severe sepsis.
Myocardial Perfusion Is Impaired and Relates to Cardiac Dysfunction in Patients With Atrial Fibrillation Both Before and After Successful Catheter Ablation
Authors: Wijesurendra Rohan S. , Liu Alexander , Notaristefano Francesco , Ntusi Ntobeko A. B. , Karamitsos Theodoros D. , Bashir Yaver , Ginks Matthew , Rajappan Kim , Betts Tim R. , Jerosch‐Herold Michael , Ferreira Vanessa M. , Neubauer Stefan , Casadei Barbara 
Published: September 2018

Background

Atrial fibrillation (
AF
) is associated with myocardial infarction, and patients with
AF
and no obstructive coronary artery disease can present with symptoms and evidence of cardiac ischemia. We hypothesized that microvascular coronary dysfunction underlies these observations.

Methods and Results

Myocardial blood flow (
MBF
) at baseline and during adenosine stress and left ventricular and left atrial function were evaluated by magnetic resonance in 49 patients with
AF
(25 paroxysmal, 24 persistent) with no history of epicardial coronary artery disease or diabetes mellitus, before and 6 to 9 months after ablation. Findings were compared with those obtained in matched controls in sinus rhythm (n=25). Before ablation, patients with
AF
had impaired left atrial function and left ventricular ejection fraction and strain indices (all
P
<0.05 versus controls).
MBF
was impaired in patients both under baseline conditions (1.21±0.24 mL/min per g·[mm Hg·bpm/10
4
]
−1
versus 1.34±0.28 mL/min per g·[mm Hg·bpm/10
4
]
−1
in controls,
P
=0.044) and during adenosine stress (2.29±0.48 mL/min per g versus 2.73±0.37 mL/min per g in controls,
P
<0.001). Under baseline conditions,
MBF
correlated with left ventricular strain and left atrial function (all
P
≤0.001), so that cardiac function was most impaired in patients with the lowest
MBF
. Baseline and stress
MBF
remained unchanged postablation (both
P
=ns), and baseline
MBF
showed similar correlations with functional indices to those present preablation (all
P
≤0.001).

Conclusions

Baseline and stress
MBF
are significantly impaired in patients with
AF
but no epicardial coronary artery disease. Reduction in
MBF
is proportional to severity of left ventricular and left atrial dysfunction, even after successful ablation. Coronary microvascular dysfunction may be a relevant pathophysiological mechanism in patients with a history of
AF
.
Measurement of Low‐Density Lipoprotein Cholesterol Levels in Primary and Secondary Prevention Patients: Insights From the PALM Registry
Authors: Lowenstern Angela M. , Li Shuang , Navar Ann Marie , Roger Veronique L. , Robinson Jennifer G. , Goldberg Anne C. , Virani Salim S. , Lee L. Veronica , Wilson Peter W. F. , Louie Michael J. , Peterson Eric D. , Wang Tracy Y. 
Published: September 2018

Background

The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low‐density lipoprotein cholesterol (
LDL
‐C) to identify untreated patients with
LDL
‐C ≥190 mg/dL, assess lipid‐lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines.

Methods and Results

The
PALM
(Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest
LDL
‐C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no
LDL
‐C levels measured in the 2 years before enrollment. Patients without chart‐documented
LDL
‐C levels were more often women, nonwhite, uninsured, and non–college graduates (all
P
<0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%;
P
=0.0034), a high‐intensity statin (21.5% versus 24.3%;
P
=0.016), nonstatin lipid‐lowering therapy (24.8% versus 27.3%;
P
=0.037), and had higher core laboratory
LDL
‐C levels at enrollment (median 97 versus 92 mg/dL;
P
<0.0001) than patients with prior
LDL
‐C testing. Of 166 individuals with core laboratory
LDL
‐C levels ≥190 mg/dL, 36.1% had no
LDL
‐C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment.

Conclusions

In routine clinical practice,
LDL
‐C testing is associated with higher‐intensity lipid‐lowering treatment and lower achieved
LDL
‐C levels.
Atrial Fibrillation Detection Using a Novel Cardiac Ambulatory Monitor Based on Photo‐Plethysmography at the Wrist
Authors: Bonomi Alberto G. , Schipper Fons , Eerikäinen Linda M. , Margarito Jenny , van Dinther Ralph , Muesch Guido , de Morree Helma M. , Aarts Ronald M. , Babaeizadeh Saeed , McManus David D. , Dekker Lukas R.C. 
Published: September 2018

Background

Long‐term continuous cardiac monitoring would aid in the early diagnosis and management of atrial fibrillation (
AF
). This study examined the accuracy of a novel approach for
AF
detection using photo‐plethysmography signals measured from a wrist‐based wearable device.

Methods and Results

ECG
and contemporaneous pulse data were collected from 2 cohorts of
AF
patients:
AF
patients (n=20) undergoing electrical cardioversion (
ECV
) and
AF
patients (n=40) that were prescribed for 24 hours
ECG
Holter in outpatient settings (
HOL
). Photo‐plethysmography and acceleration data were collected at the wrist and processed to determine the inter‐pulse interval and discard inter‐pulse intervals in presence of motion artifacts. A Markov model was deployed to assess the probability of
AF
given irregular pattern in inter‐pulse interval sequences. The
AF
detection algorithm was evaluated against clinical rhythm annotations of
AF
based on
ECG
interpretation. Photo‐plethysmography recordings from apparently healthy volunteers (n=120) were used to establish the false positive
AF
detection rate of the algorithm. A total of 42 and 855 hours (AF: 21 and 323 hours) of photo‐plethysmography data were recorded in the
ECV
and
HOL
cohorts, respectively.
AF
was detected with >96% accuracy (
ECV,
sensitivity=97%;
HOL
, sensitivity=93%; both with specificity=100%). Because of motion artifacts, the algorithm did not provide
AF
classification for 44±16% of the monitoring period in the
HOL
group. In healthy controls, the algorithm demonstrated a <0.2% false positive
AF
detection rate.

Conclusions

A novel
AF
detection algorithm using pulse data from a wrist‐wearable device can accurately discriminate rhythm irregularities caused by
AF
from normal rhythm.
Differential Impact of Acute Lesions Versus White Matter Hyperintensities on Stroke Recovery
Authors: Hawe Rachel L. , Findlater Sonja E. , Kenzie Jeffrey M. , Hill Michael D. , Scott Stephen H. , Dukelow Sean P. 
Published: September 2018

Background

Understanding how the size of acute lesions and white matter hyperintensities (
WMH
) impact stroke recovery can improve our ability to predict outcomes and tailor treatments. The aim of this exploratory study was to investigate the role of acute lesion volume and
WMH
volume on longitudinal recovery of specific sensory, motor, and cognitive impairments after stroke using robotic and clinical measures.

Methods and Results

Eighty‐two individuals were assessed at 1, 6, 12, and 26 weeks poststroke with robotic tasks and commonly used clinical measures. The volumes of acute lesions and
WMH
were measured on fluid‐attenuated inversion recovery images. Linear mixed models were used to investigate the role of acute lesions and
WMH
on parameters derived from the robotic tasks and clinical measures. Regression analysis determined the added value of acute lesion and
WMH
volumes along with measures of initial performance to predict outcomes at 6 months. Acute lesion volume has widespread effects on sensory, motor, and overall functional recovery poststroke. The impact of
WMH
was specific to cognitive impairments. Apart from the robotic position sense task, neither lesion volume nor
WMH
measure had significant ability to predict outcomes at 6 months over using initial impairment as measured by robotic assessments alone.

Conclusions

While acute lesion volume and
WMH
may impact different impairments poststroke, their clinical utility in predicting outcomes at 6 months poststroke is limited.