bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effects of sodium-glucose cotransporter 2 inhibitors on pulmonary hemodynamics in chronic heart failure patients with a pulmonary artery pressure sensor
Authors: Santiago-Vacas E , Rovira-Sole J , Codina P , Carrete A , Borrellas A , Domingo M , Ruiz-Cueto M , Cediel G , Camblor A , Gonzalez B , Velayos P , Crespo E , Pulido A , Lupon J , Bayes-Genis A 
Published: October 2024

Abstract

Background
Approximately 50% of patients with chronic heart failure (HF), either with preserved or reduced left ventricular ejection fraction (LVEF), have secondary pulmonary hypertension, which results in poorer prognosis. In previous studies, sodium-glucose cotransporter 2 inhibitors (SGLT2i) have shown a reduction in cardiovascular death, HF hospitalization and pulmonary artery pressure (PAP) in patients with HF, regardless of LVEF, but exact mechanisms remain unclear.

Purpose
The main objective of this study is to analyse effects of SGLT2i on PAP in patients with chronic HF followed by a PAP sensor (CardioMEMS HF system). The secondary objective is to analyse effects in subgroups of LVEF.

Methods
We included chronic HF patients (regardless of LVEF) with previously implanted a PAP sensor, from July 2019 to February 2023. SGLT2i had been added in fourth position in patients with reduced LVEF, since they were previously on optimal HF treatment as chronic patients. Changes in PAP, renal function and N-terminal pro B-type natriuretic peptide (NTproBNP) were compared between two periods of time: "30 days before" and "30 days after" SGLT2i initiation. Patients were then classified in two groups: group 1 (LVEF ≤40%) and group 2 (LVEF &gt;40%) and repeated same analyses.

Results
Overall, 61 patients were screened, and 17 finally were included, mean age 71.7 ± 9.6 years, 64.7% were men, mean LVEF was 49.4 ± 17.5%, 23.5% had ischaemic aetiology and 64.7% were in NYHA class III (Table 1). There were more men in group 1 than in group 2 (p=0.043), without other differences in basal characteristics between groups (Table 1). Dapagliflozin (10mg daily) was initiated in 14 patients (82.4%), 5 from group 1 and 9 from group 2 (p=1.000), and empagliflozin (10mg daily) in 3 patients (17.6%), 1 from group 1 and 2 from group 2 (p=1.000). Before SGLT2i, mean diastolic PAP (dPAP) was 17.3 ± 5.6 mmHg and median NTproBNP was 2841.5 (289-10515) pg/mL. SGLT2i significantly reduced dPAP; average dPAP ("30 days after" period) was 1.5 mmHg lower (95% CI, 0.26-2.74; p=0.021) compared to "30 days before" period (Figure 1). SGLT2i also reduced systolic PAP (-2.2 mmHg), mean PAP (-1.7 mmHg), NTproBNP (-183 pg/mL) and creatinine (-0.2 mg/dL), but not statistically significant. SGLT2i reduced PAP, NTproBNP and creatinine too in group 1 (6 patients), but did not achieve statistical significance. Reductions were as well observed in group 2 (11 patients), and SGLT2i significantly reduced dPAP (-2.04 mmHg) (95% CI, 0.31-3.77; p=0.025).

Conclusions
In patients with chronic HF and a PAP sensor, SGLT2i, added to previous HF treatment, significantly reduced dPAP. PAP reductions were observed regardless LVEF, but results were more robust in patients with LVEF &gt;40%.Figure 1
The efficacy of IV iron in anemic heart failure patients: a systemic review and meta-analysis of randomised controlled trials
Authors: Desouki M R A , Abdelaziz A , Khatatbeh A A , Ramadan S , Rasheed W M , Eldamanhory M H , Aref Alqurm A K , Heiba A H , Aly Zaher A A , Mostafa Elsayed D E , Abdelazeem B , Lavie C J , Slipczuk L 
Published: October 2024

Abstract

Introduction
Iron deficiency in the context of heart failure is a multifaceted concern, where the intricate interplay between diminished iron stores, impaired absorption mechanisms, and reduced recycled iron in the reticuloendothelial system adds a layer of complexity to patient management. Initial attempts to address this issue with oral iron treatments have been questioned due to its poor absorption. Intravenous iron therapy is now preferred, as it has been shown to reduce heart failure hospitalisations and cardiovascular mortality. However, there is a lack of randomised studies specifically focused on heart failure patients, highlighting the need for more targeted investigations.

Purpose
The aim of this review is to provide reliable evidence from published randomised controlled trials (RCTs) regarding the beneficial effect of IV iron in heart failure patients.

Methods
We systematically searched PubMed, Web of Science, Scopus, and Cochrane Central, and EMBASE from inception until December 2023. We included randomised controlled trials (RCTs) comparing the effect of IV iron in heart failure patients versus placebo. The primary outcomes were 6MWT mean change, ferritin concentration mean change, transferrin saturation mean change and worsening heart failure. All data were pooled as either Mean difference in the random effect model with the corresponding SD or pooled as RR and 95% CI for dichotomous data.

Results
Twelve RCTs involving 6800 patients were included in the analysis. The overall effect on the measured primary outcomes was in favour of IV iron in terms of 6MWT mean change (MD= 34.45, 95% CI [ 29.58 to 39.31], P=&lt;0.0001), ferritin concentration mean change (MD= 219.18, 95% CI [ 208.7 to 229.66], P=&lt;0.0001), transferrin saturation mean change (MD= 9.77, 95% CI [ 8.14 to 1.39], P=&lt;0.0001) and worsening heart failure (RR= 0.46, 95% CI [ 0.31 to 0.69], P=0.002).

Conclusion
The introduction of the IV iron therapy to heart failure patients showed a beneficial effect in terms of the measured haematological and cardiovascular metrics, which include 6MW test mean change, ferritin concentration mean change, and worsening heart failure.6MWT mean changeFerritin mean change
Long-term safety and efficacy of antibody ALXN2220 for depletion of cardiac amyloid transthyretin: results of treatment beyond 12 months in the open-label extension of study NI006-101
Authors: Van Der Meer P , Lairez O , Donal E , Aus Dem Siepen F , Kristen A , Damy T , Quarta C , Mercuri M , Nitsch R M , Grimm J , Rey S , Tichy M , Kahr P C , Hock C , Garcia-Pavia P 
Published: October 2024

Abstract

Introduction
ALXN2220 (formerly NI006) is an investigational human monoclonal antibody in development for the treatment of transthyretin-mediated amyloid cardiomyopathy (ATTR-CM). ALXN2220 is designed to deplete cardiac amyloid transthyretin (ATTR) deposits in patients with ATTR-CM on top of standard of care. Data from the first-in-human, ascending dose study NI006-101 show that ALXN2220 is safe and well tolerated. A reduction of surrogate markers of cardiac amyloid load and cardiac biomarkers was observed in participants receiving doses of ≥ 10mg/kg of ALXN2220 over a period of 12 months of treatment.

Purpose
Long-term safety, tolerability and efficacy of ALXN2220 treatment beyond 12 months was studied in a prolonged Open-Label Extension (OLE) of the NI006-101 study.

Methods
Participants completing 12 months in dose cohorts ≤ 30 mg/kg were allowed to receive additional 6 to 12 monthly open-label ALXN2220 infusions with up-titration of all participants to 30 mg/kg. Cardiac biomarkers were measured centrally, and serial cardiac imaging was performed with echocardiography and cardiac MRI or scintigraphy.

Results
Out of 27 participants completing 12 months, 23 (18 ATTRwt, all male, median age 70 years at screening (range 28-83)) continued treatment in the prolonged OLE. Median number of infusions of ALXN2220 received and median time followed across the full study were 20 infusions (range 11-24) and 125 weeks (range 83-153). Overall adherence to treatment was high in the prolonged OLE, 97% of planned infusions administered, 87% of participants received all planned doses. No severe or serious adverse events were considered related to ALXN2220 or resulted in the discontinuation during OLE, and no events of cytokine release syndrome or thrombocytopenia were observed. None of the participants had anti-drug antibodies throughout the trial. Cardiac biomarkers (NT-proBNP, troponin) and cardiac imaging indicated continued treatment effects beyond 12 months and supported the up-titration of participants who previously received lower doses of ALXN2220.

Conclusions
Up-titration and long-term treatment at a dose level of 30 mg/kg in the OLE was safe and well tolerated, with overall good adherence to treatment. Cardiac imaging and cardiac biomarker data indicated continued treatment effects beyond 12 months and supported the up-titration of patients to 30 mg/kg.
Acetazolamide for patients with acute decompensated heart failure: a systematic review and meta-analysis of randomised controlled trials
Authors: Kritya M , Lingamsetty S S P , Fatima S R , Gewehr D M , Pastrana S H , Huang W , Doma M , Naji Z , Hamdanieh M , Martignoni F V 
Published: October 2024

Abstract

Background
The role of acetazolamide as an adjunct to standard loop diuretic therapy in patients with acute decompensated heart failure (ADHF) remains uncertain.

Purpose
We undertook a systematic review and meta-analysis to ascertain the efficacy and safety of acetazolamide plus standard of care (SOC) in patients with ADHF.

Methods
In January 2024, we systematically searched PubMed, Embase, and Cochrane for randomised controlled trials (RCTs) comparing acetazolamide plus SOC versus SOC alone in patients with ADHF. Effective decongestion was defined as per the definition of each individual study. We pooled risk ratios (RR) and standardized mean difference (SMD) with 95% confidence intervals (CI) for binary and continuous outcomes, respectively. Statistical analyses were performed using Review Manager version 5.4.1.

Results
We included 4 RCTs comprising 634 patients, of whom 318 (50.1%) were randomised to acetazolamide plus SOC. The mean age was 77.1 years and 64.2% were male. Nearly half of the patients (n=320; 50.5%) had impaired left ventricular ejection fraction at baseline. Most patients had a New York Heart Association functional class III or higher, ranging from 75 to 91% in each study. In the pooled analysis, acetazolamide plus SOC significantly increased the proportion of patients with clinical decongestion at day 3 compared with SOC alone (RR 1.36; 95% CI 1.10 to 1.68; p=0.005; Figure 1A). There was no significant difference between groups in natriuresis at day 1 (SMD 0.46; 95% CI -0.01 to 0.94; p=0.06; Figure 1B) or worsening renal function (RR 1.71; 95% CI 0.73 to 3.98; p=0.22; Figure 1C).

Conclusion
In this meta-analysis of RCTs among patients admitted with ADHF, acetazolamide plus SOC significantly improved the proportion of patients with clinical decongestion at day 3 relative to SOC alone, without significantly affecting renal function or natriuresis.Figure 1
Effects of dapagliflozin according to QRS duration across the spectrum of LVEF: An analysis of DAPA-HF and DELIVER
Authors: Abdin A , Kondo T , Boehm M , Jhund P S , Vaduganathan M , Lam C S P , De Boer R , Kosiborod M N , Desai A S , Kober L , Ponikowski P , Martinez F A , Hernandez A , Solomon S , Mcmurray J 
Published: October 2024

Abstract

Aims
To document the prevalence of QRS prolongation in patients with HFrEF and HFmrEF/HFpEF, the association between QRS duration and outcomes, and the effect of dapagliflozin according to QRS duration across the spectrum of LVEF.

Methods
A pooled analysis of the DAPA-HF and DELIVER trials, excluding patients with a paced rhythm and CRT was conducted. The information collected was used to categorize patients according to QRS duration based on the cutpoints used in the CRT trials, as follows: QRS &lt;120 ms, QRS 120-149 ms, and QRS ≥ 150 ms. The data were analyzed according to these categories and using QRS duration as a continuous variable.

Results
Overall, 4004 patients had HFrEF, and 5820 had HFmrEF/HFpEF. QRS duration (ms) was &lt;120 in 7039 patients (71.7%), 120–149 in 1725 (17.6%), and ≥150 in 1060 patients (10.8%). The median follow-up time was 23 months. The rate of the primary composite outcome of CV death or worsening HF was 9.2 (95%CI 8.7-9.7), 14.3 (13.0-15.7), and 15.9 (14.1-17.9) per100 patient-years in the &lt;120, 120–149, and ≥150 ms groups, respectively. This gradient in event rates was observed both in HFrEF and HFmrEF/HFpEF. Dapagliflozin, compared with placebo, reduced the risk of the primary outcome, consistently, across the QRS duration subgroups: hazard ratio (95% CI) 0.75 (0.67-0.85), 0.79 (0.65-0.96) and 0.89 (0.70-1.13) in the &lt;120, 120–149, and ≥150 ms groups, respectively (P for interaction 0.28). The effect of dapagliflozin on the primary outcome was consistent across the QRS duration regardless of HF phenotype i.e., HFrEF or HFmrEF/HFpEF.

Conclusion
Prolongation of QRS duration is associated with worse outcomes irrespective of HF phenotype. Dapagliflozin reduced the risk of the primary outcome, regardless of QRS duration, in DAPA-HF and DELIVER.KM curves according to QRS durationEffect of dapagliflozin on outcomes
Impact of left ventricular lead position on echocardiographic response after upgrading from right to biventricular pacing - Insights from the BUDAPEST CRT Upgrade Trial
Authors: Merkely B , Merkel E D , Hatala R , Szigeti M , Behon A , Veres B , Lakatos B K , Osztheimer I , Geller L , Zima E , Molnar L , Kutyifa V , Kovacs A , Kosztin A 
Published: October 2024

Abstract

Introduction
Left ventricular (LV) lead position is strongly associated with the long-term outcome of patients undergoing de novo cardiac resynchronization therapy (CRT) implantation. However, data is scarce about patients who undergo upgrade CRT from right ventricular (RV) pacing.

Aims
To investigate the impact of the LV lead location on the primary outcome of heart failure (HF) hospitalization, all-cause mortality, or echocardiographic reverse remodelling in the BUDAPEST CRT Upgrade trial cohort.

Methods
Heart failure patients with reduced ejection fraction (HFrEF), with previously implanted pacemaker (PM) or implantable cardioverter defibrillator (ICD) and intermittent or permanent RV pacing, who were randomly assigned to the CRT-D arm (n=215) and those who were cross-overs from the ICD arm (n=27) were investigated. Short-axis position (anterior / posterior / lateral) of the LV lead was assessed. Primary endpoint encompassed HF hospitalization, all-cause mortality, and the end-systolic volume (ESV) decrease less than 15% from baseline to 12 months follow-up. Echocardiographic response was evaluated by percent change of ESV and LVEF.

Results
LV lead location was available for 223 patients (age 72.8 ± 8 years, 14% female, 38% diabetic, 49% with prior myocardial infarction, 30% with prior ICD) with a median follow-up time of 12.4 months. There was no difference in the occurrence of the primary endpoint by the lead positions (anterior vs. lateral OR 0.33; 95%CI 0.09-1.22, p=0.10, anterior vs. posterior OR 0.58; 95%CI 0.14-2.50, p=0.47). However, LVEF change was more pronounced in those with lateral LV lead location compared with anterior position (adjusted LVEF difference 7.43%, 95%CI 1.25 – 13.62; p=0.02), while those with posterior leads did not differ from the anterior ones (adjusted LVEF difference 3.00%, 95%CI -3.92 – 9.93; p=0.39). Decrease in ESV was also more remarkable with a lateral position as compared to the other locations (lateral vs. anterior adjusted ESV difference -0.17 mL, 95%CI -0.32 – (-0.01); p=0.03, posterior vs. anterior adjusted ESV difference -0.09 mL, 95%CI -0.26– 0.08; p=0.31).

Conclusion
Upgrade CRT results in better outcomes as compared to ICD alone; however, lateral LV lead position is associated with the most beneficial mid-term echocardiographic response as compared to other short-axis locations. This finding may translate into better clinical outcomes in the long term.
Outcomes of intra-aortic balloon pump in patients with advanced heart failure and cardiogenic shock undergoing heart transplantation
Authors: Bellini V , Fatori D , De Mateo F G , Loureiro G J F , Macatrao M F , Bernoche C , Kopel L , Lage S G 
Published: October 2024

Abstract

Background
Intra-aortic balloon pump (IABP) is generally used as a short-term device to maintain adequate organ perfusion in patients with cardiogenic shock (CS). However, whether IABP improves clinical outcomes as a bridge therapy for heart transplant (HTx) remains controversial.

Purpose
Evaluate the survival rate 30 days after heart transplant (HTx) in patients with advanced heart failure (HF) and CS using IABP pre transplant compared to non-IABP group.

Methods
We retrospectively analyzed consecutive patients with advanced HF and CS, admitted in the cardiac intensive care unit (ICU) of a tertiary university center, between 2009 and 2020, who underwent HTx. Study group included patients submitted to IABP implantation before HTx, and a non-IABP group submitted to HTx without left ventricular mechanical support. Propensity Score Matching was used to pair the groups according to relevant clinical covariates. The primary outcome of survival rate 30 days after HTx was estimated by the Kaplan-Meier method.

Results
326 were enrolled, 199 in IABP group and 127 in non-IABP group. For non-IABP and IABP group, respectively, the most frequent etiology was Chagas disease (29,9% and 47,2%, p=0,006) followed by idiopathic cardiomyopathy and ischemic cardiomyopathy, the majority of patients were male (63% and 61,3%, p=0,760), the mean age was 46,9 ± 14,4 and 46,5 ± 12 years (p=0,791) and mean left ventricular ejection fraction was 25,9 ± 9,5% and 23,5 ± 5,9% (p=0,010). The Simplified Acute Physiology Score 3 (SAPS 3) at ICU admission was compared in both groups, which was 36,8% ± 17,8% in non-IABP group and 32,6% ± 18,6% in IABP group (p=0,042). At 30 days after HTx, there was no statistical difference in overall survival (p=0,459) between the groups (IABP: 18,1% mortality; non-IABP: 14,2% mortality). Survival rate after HTx was also similar in patients with Chagas disease compared to the other etiologies in both study groups (IABP group: p=0,221; non-IABP group: p=0,421).

Conclusion
In patients with advanced HF and CS submitted to HTx, the survival rate 30 days after HTx was equivalent in the IABP and non-IABP groups. In patients with Chagas disease the survival was also similar compared to other etiologies in both groups.Characteristics according to groupsKaplan-Meier survival estimates
Ventricular arrhythmia characteristics after left ventricular assist device implantation
Authors: Li X , Qing P , Du J , Zou L , Zhou X T , Chen H B , Duan F J , Yu L T , Yao Y , Wang X Q , Hu S S 
Published: October 2024

Abstract

Background
Ventricular arrhythmia (VA) characteristics in patients with advanced heart failure (HF) and left ventricular assist devices (LVADs) are currently poorly studied.

Methods
Patients with advanced HF implanted with third-generation LVADs during 2019-2023 were enrolled, and six-month post-LVAD VA events were retrospectively analyzed. Baseline characteristics, 6-month VA events, Holter monitoring and ambulatory blood pressure were also analyzed. Post-LVAD VA events were categorized as new right bundle-branch block (RBBB) superiorly directed VA and prior VA recurrence.

Results
Fifty-four advanced HF patients (90.7% male, 50.0±13.7 years old) who underwent LVAD (CH-VAD: n=23; Evaheart2: n=10; Corheart6: n=21) were consecutively enrolled in this study. Twenty-two patients suffered post-LVAD VA events (15 new RBBB superiorly directed VA, 7 prior VA recurrence), and 94.4% of the patients were hemodynamically stable. A total of 46.3% of the patients presented with a 50% reduction in VA burden, and amiodarone use decreased from 25.9% to 16.7%. The nighttime mean arterial pressure (MAP) and maximum inferior venous cava (IVC) diameter had opposite predictive effects on the new RBBB VA, and the post-LVAD left ventricular ejection fraction (LVEF) was negatively correlated with the prior VA recurrence. Multivariate analysis revealed that a higher nighttime MAP/IVC ratio (OR 2.24, 95% CI 2.22-4.52; P=0.025) and a lower post-LVAD LVEF (OR 0.75, 95% CI 0.57-0.99; P=0.048) were independently related to the new RBBB superiorly directed VA and prior VA recurrence, respectively.

Conclusion
The overall VA burden decreased after LVAD implantation. Volume deficiency and poor post-LVAD cardiac function were associated with different VA patterns.Changes in VAs pre- and 6 monthsVA distributions of patients
A meta-analysis of the efficacy and safety of exercise-based cardiac rehabilitation in patients with left ventricular assist devices
Authors: Abuelazm M , Ibrahim A , Amin A , Khan U , Rezq H , Elbenawi H , Abdelnabi M , Shaban M , Abouzid M , Abdelazeem B 
Published: October 2024

Abstract

Background
Left Ventricular Assist Devices (LVADs) and heart transplantation stand out as the two well-established and effective therapeutic approaches for managing patients with advanced heart failure. Exercise-based cardiac rehabilitation (EBCR) has been demonstrated to improve functional capacity in patients with LVAD.

Purpose
We aim to assess the efficacy and safety of EBCR in patients with LVAD. Also, to compare high-intensity (HIT) versus moderate-intensity (MIT) EBCR regimens in patients with LVAD.

Methods
A systematic review and meta-analysis synthesizing evidence from randomized controlled trials (RCTs) studies obtained from PubMed, Embase Cochrane, Scopus, and WOS until January 2024. We used the fixed-effects model to report dichotomous outcomes using risk ratio (RR) and continuous outcomes using standardized mean difference (SMD) with a 95% confidence interval (CI).

Results
Six RCTs with 160 patients were included. There was no significant difference between EBCR and standard care regarding peak VO2 change [SMD: 0.24 with 95% CI (-0.14, 0.62), P= 0.21] and six-minute walk distance (6-MWD) change [SMD: 0.28 with 95% CI (-0.11, 0.66), P= 0.16]. Also, there was no significant difference between HIT and MIT exercise regarding peak VO2 change [SMD: 0.20 with 95% CI (-0.41, 0.82), P= 0.52] and 6-MWD change [SMD: 0.07 with 95% CI (-0.54, 0.69), P= 0.81]. Moreover, EBCR was associated with a significant decrease in the incidence of any adverse events when compared to usual care with [RR: 0.80 with 95% CI (0.65, 0.99), P= 0.04], while there was no significant difference between HIT and MIT exercise regarding the incidence of any adverse events [RR: 0.38 with 95% CI (0.02, 9.22), P= 0.55].

Conclusion
EBCR did not improve functional capacity in patients with LVAD, with no significant effect on peak VO2 or 6-MWD.