bluuebunny/crossref_metadata_2025_split huggingface dataset:
Development of machine learning models for prediction of left ventricular systolic dysfunction in patients with isolated left ventricular dilation
Authors: Saleh A , Sotelo M , Nona P , Wagner L , Rodgers C , Booker O , Andrikopoulou E 
Published: October 2024

Abstract

Background/Introduction
Isolated left ventricular dilation (ILVD), in the absence of concomitant LV systolic dysfunction, is a risk factor for new reduction in LV ejection fraction (LVEF) and adverse clinical outcomes. We assessed the performance of different machine learning (ML) models in predicting new reduction in LVEF in patients with ILVD.

Methods
A retrospective analysis of de-identified patient records in the Tempus Database with at least two transthoracic echocardiograms (TTE) conducted between January 2019 and December 2022 were retrospectively analyzed, with the follow up period ending in January 2023. Inclusion/exclusion criteria are shown in Figure 1A. Briefly, patients with ILVD were defined based on echocardiographic parameters as those with LVEF &gt; 50% and LV end diastolic volume indexed (LVEDVi) &gt; 62 mL/m2 for females and &gt; 75 mL/m2 for males, without prior LVEF &lt; 50% and/or grade 2/3 diastolic dysfunction. The endpoint was LVEF &lt; 40% on future (≥90 days) TTE. Five hard voting ML models and one soft voting ensemble model were trained with data parsed from TTE reports (Figure 1B). Feature importance (SHAP) was calculated, and receiver operating characteristic (ROC) and Kaplan Meier curves evaluated the final model (Figure 1C-E).

Results
A total of 2,962 patients met the inclusion criteria. The median time from index to last TTE was 578 (IQR = 500) days. LVEF &lt; 40% on follow up TTE was noted in 6% of patients (177 patients, median 478 days to endpoint, IQR = 535 days). Of the six models developed, the ensemble model had the highest ROC area under the curve (0.791, Figure 1D), precision (0.163), F1-score (0.266), and specificity (0.773). The ensemble model also had the lowest predicted prevalence (25.5%), although this was higher than the observed prevalence in the test set (5.7%). Patients predicted to develop LVEF &lt; 40% had a 8.2x higher risk of developing LVEF &lt; 40% within five years of index (p&lt;0.001, Figure 1E). Feature importance showed that male gender, higher heart rate, lower LVEF at index TTE, higher LVEDVi, and lower tricuspid annular plane systolic excursion had the highest mean absolute impact on the model’s output probability (Figure 1C).

Conclusion
Using only data parsed from the index TTE, ensembling a model for the prediction of developing LVEF &lt; 40% in patients with ILVD and without a history of LV diastolic or systolic dysfunction performed the best. Additional analyses including clinical variables such as comorbidities, symptoms, and medications may improve the model’s performance.
Residual mitral leaflet length independently indicates left ventricular outflow tract obstruction in hypertrophic cardiomyopathy
Authors: Zach D K , Batzner A , Schwegel N , Santner V , Hoeller V , Ablasser K , Morbach C , Stoerk S , Maack C , Reiter U , Rainer P P , Frantz S , Zirlik A , Seggewiss H , Verheyen N 
Published: October 2024

Abstract

Background
Due to its dynamic character, the diagnosis of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) often requires extensive exercise testing. Mitral valve alterations represent structural parameters that are not affected by load or contractility and influence left ventricular outflow tract (LVOT) gradients. The residual portion of the mitral valve extending past its coaptation (RML) has been postulated as a necessity to exhibit LVOTO.

Purpose
This study aims to assess the impact of RML length on the likelihood of LVOTO in HCM patients.

Methods
This is a cross-sectional, multi-center, registry-based analysis conducted at two HCM referral centers. The study included HCM patients with valid standardized transthoracic echocardiographic examinations. Blinded investigators performed post-processing echocardiographic analyses. LVOTO was defined as resting or dynamic peak LVOT gradients ≥30 mmHg.

Results
Among 270 HCM patients studied (43% women, mean age 58±14 years), 131 patients (49%) exhibited LVOTO, with 76 (28%) having undergone septal reduction therapy (SRT). Patients with obstructive HCM exhibited a more pronounced end-diastolic interventricular septum (IVSd) thickness (2.2±0.4 vs. 1.8±0.5 cm; p&lt;0.001) and higher left ventricular ejection fraction (LVEF) (65±9 vs. 62±10%; p=0.009) compared to those without LVOTO (nHCM). Obstructive HCM patients demonstrated longer anterior (29±4 vs. 26±4 mm; p&lt;0.001), posterior (23±4 vs. 20±4 mm; p&lt;0.001), and residual mitral leaflets (11±3 vs. 7±3 mm; p&lt;0.001) than nHCM patients. Multivariable logistic regression analysis adjusting for age, IVSd thickness, LVEF, anterior, and posterior mitral leaflet length identified RML length as an independent predictor of LVOTO [OR=1.47 (95% CI 1.30-1.66); p&lt;0.001]. The area under the receiver-operating characteristic curve for RML length in identifying LVOTO was 0.82 (95% CI 0.77-0.87). RML length ≥9 mm demonstrated 73% sensitivity and 77% specificity in identifying obstructive HCM patients. Notably, these results remained statistically significant in sensitivity analyses selectively performed in HCM patients who had previously undergone SRT as well as in those who were SRT-naïve, respectively.

Conclusions
This study indicates RML length as an independent predictor of LVOTO in HCM patients. Moreover, RML length demonstrated high diagnostic accuracy in identifying LVOTO among HCM patients. Prospective studies are warranted to assess the added value of RML length in the diagnostic work-up of HCM patients.Figure:Diagnostic Accuracy of RML
Right ventricular myocardial work predicts heart failure hospitalizations irrespective of ejection fraction
Authors: Chilingaryan A , Tunyan L G , Asatryan A A , Sisakyan J G 
Published: October 2024

Abstract

Hospitalization for heart failure worsening (HFW) associates with increased subsequent rehospitalization rate and mortality irrespective of left ventricular ejection fraction (EF). However there’s little evidence regarding predictors of HFW to timely apply preventive measurements. Since right ventricular (RV) dysfunction often associates with more advanced stages of HF we assumed that RV myocardial work (MW) assessment might be used in prediction of HFW.

Methods
158 patients with HF (48% female) 58±7 years on guideline directed medical therapy in sinus rhythm and with at least one hospitalization in the last 6 months were enrolled in the study. Patients with HFrEF, HFmrEF and HFpEF were evenly represented. All patients were appropriately decongested prior to the study. The primary outcome was rehospitalization, HFW or cardiovascular death. RVMW was derived from RV global strain, including interventricular septum, and noninvasively estimated pulmonary arterial pressure (PAP). Systolic PAP (sPAP) was measured as the sum of maximum RV and right atrial (RA) pressure gradient (PGmax) from tricuspid regurgitation (TR) jet peak velocity and mean right atrial pressure (RAP) estimated from diameter and collapsing of inferior vena cava. Mean PAP (mPAP) was measured as the sum of PGmean RV-RA by tracing TR jet and RAP. Diastolic PAP was estimated as dPAP = 1.5 × [mPAP − (sPAP/3)]. Then RV global work index (RVGWI), constructive (RVGCW), and efficient work (RVGWE) were derived by the software dedicated for left ventricular MW. Left ventricular global longitudinal strain, left atrial (LA) reservoir strain (LAS), LA pump strain, LA volume index (LAVi), B lines, inferior vena cava, NT-pro-BNP, TAPSE/sPAP and RVMW were also measured. Patients followed up for 12 months.

Results
53 events were registered at 12 months of which 42 rehospitalizations due to HFW and 11 CV deaths. Among all parameters in the multivariate analysis lower RVGCW was associated with HFW (HR 0.978, 95% CI 0.973–0.998, p = 0.014). RVGCW was the most powerful predictor of CV events (AUC 0.91) with cut off value of 148 mmHg% that had 96% sensitivity and 88% specificity. Number of patients who died with RVGCW &lt; 148 mmHg% was 8 of 11 (73%) total deaths (HR 0.421, 95% CI 0.083–0.986, p = 0.028).

Conclusion
RVGCW was a predictor of HFW and 1 year mortality in patients with HF irrespective of EF.
Left atrioventricular coupling index: association with diastolic dysfunction and prognostic implications in heart failure patients
Authors: Fortuni F , Biagioli P , Myagmardorj R , Mengoni A , Lupi A , Chua A P , Zuchi C , Sforna S , Di Pietro I , Viti C , Bax J , Ajmone Marsan N , Ambrosio G , Carluccio E 
Published: October 2024

Abstract

Background
Left atrioventricular coupling index (LACI), an index coupling left atrial (LA) to left ventricular (LV) volume at end-diastole (Figure 1), showed to be associated with prognosis in different clinical settings. However, the relation between LACI and LV diastolic dysfunction (DD) remains to be established.

Purpose
The present study aimed to investigate the association between LACI and LV DD and to assess its prognostic value in patients with heart failure (HF).

Methods
We retrospectively analyzed 1158 stable HF patients (mean age 66±12 years, 75% men) on optimal medical therapy (derivation cohort). Clinical and echocardiographic features were characterized across LACI tertiles. The independent prognostic value of LACI (endpoint: all-cause death/HF-hospitalization) was assessed by Cox regression and spline curve analyses. Results were validated in an external cohort of 242 HF patients.

Results
In the derivation cohort, the median LACI value was 0.29 (IQR:0.19-0.42). Patients in the third tertile (LACI&gt;0.36) were older and presented with more advanced HF symptoms. While prevalence of grade-1 DD (ASE/EACVI classification) progressively decreased across LACI tertiles, the prevalence of grade-3 DD significantly increased (8%,23%, and 46% respectively, P&lt;0.0001). A cut-off value ³0.26 identified moderate-to-severe DD with an area-under the-curve of 0.75. During follow-up (median 28 months, IQR:11-53), 407 (35%) patients reached the endpoint. On multivariable analysis, LACI was independently associated with outcomes (HR for 1-unit-increase 2.34; 95%CI 1.35-4.03; P=0.002 – Figure 2), showing incremental predictive value over the DD grading system (net reclassification improvement=0.150, P&lt;0.0001). The prognostic value of LACI was consistent in the external validation cohort.

Conclusions
LACI is associated with DD severity and is an independent predictor of outcomes in HF patients.How to assess LACIPrognostic value of LACI in HF
Advanced versus conventional echocardiographic parameters of right ventricular-arterial coupling in heart failure
Authors: Sforna S , Fortuni F , Biagioli P , Massei F , Grassano D , Gobbi F , Fede E , Casini B , Ambrosio G , Carluccio E 
Published: October 2024

Abstract

Background
Right ventricular-arterial coupling (RVAC) is an important predictor of prognosis in heart failure (HF). Several echocardiographic RVAC parameters have been described. However, which one best reflects patient’s prognosis is still matter of debate.

Purpose
The aim of this study was to compare the predictive value of RVAC parameters derived from advanced echocardiography with that obtained from conventional echocardiography in HF patients.

Methods
Consecutive patients with stable HF and left ventricular (LV) systolic dysfunction (LVEF&lt;50%, n=193) were studied by echocardiography. RVAC was assessed by tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP), tissue Doppler imaging Sm velocity (TDI Sm)/PASP, RV free wall longitudinal strain (RVFWLS)/PASP and tridimensional RVEF (3D-RVEF)/PASP. Primary composite endpoint was all-cause death/HF hospitalization.

Results
After a median follow-up time of 16.3 months, the endpoint occurred in 45 patients. At univariable analysis, all RVAC parameters were significantly associated with the outcome [TAPSE/PASP: HR 0.31 (95% CI 0.17-0.55), P&lt;0.001; TDI Sm/PASP: HR 0.27 (95% CI 0.15-0.49), P&lt;0.001; RVFWLS/PASP: HR 0.19 (95% CI 0.10-0.36), P&lt;0.001; 3D-RVEF/PASP: HR 0.30 (95% CI 0.17-0.55), P&lt;0.001; figure 1]. At multivariable analysis, after adjustment for MAGGIC risk score and NT-proBNP, TAPSE/PASP [HR 0.71 (95% CI 0.38-1.35), P = NS] and TDI Sm/PASP [HR 0.59 (95% CI 0.31-1.10), P = NS] were no longer statistically associated with the endpoint; however, both RVFWLS/PASP [HR 0.36 (95% CI 0.18-0.70), P &lt; 0.01] and 3D-RVEF/PASP [HR 0.55 (95% CI 0.31-0.99), P &lt; 0.05] maintained their prognostic value (figure 2).

Conclusions
Advanced RVAC echocardiographic parameters (RVFWLS/PASP and 3D-RVEF/PASP) are superior predictors of prognosis than those derived from conventional echocardiography (TAPSE/PASP and TDI Sm/PASP) in a contemporary cohort of HF patients with left ventricular systolic dysfunction.Figure 1Figure 2
Randomized trial assessing worsening renal function with dapagliflozin addition in acute decompensated heart failure: ROAD-ADHF trial
Authors: Kawanami S , Egami Y , Abe M , Osuga M , Nohara H , Ukita K , Kawamura A , Yasumoto K , Okamoto N , Matsunaga Y , Yano M , Nishino M 
Published: October 2024

Abstract

Background
Dapagliflozin (DAPA), a sodium-glucose co-transporter 2 inhibitor, has shown to reduce cardiovascular mortality in patients with chronic heart failure.1) In addition, DAPA can enhance diuresis in patients with acute decompensated heart failure (ADHF).2) However, there is little known how early initiation of DAPA might impact the worsening renal function (WRF) when combined with standard decongestive therapy for ADHF.

Purpose
We aimed to evaluate the impact of initiating DAPA within 24 hours after ADHF admission on WRF, compared to standard decongestive therapy with loop diuretics alone.

Methods
We enrolled consecutive ADHF patients with a left ventricular ejection fraction (LVEF) less than 50%. The patients were prospectively randomized to either the DAPA group who received DAPA at a dose of 10 mg once daily within 24 hours of admission or the conventional therapy group (CON group) who received loop diuretics alone. Furosemide, loop diuretic, dosage was adjusted by increase or decrease of 10 mg to maintain urine output between a 1-2 mL/kg/hour.3) The primary endpoint was the incidence of WRF, which was defined as an increase in the serum creatinine of ≥ 0.3 mg/dL from baseline within 7 days of admission.4) Additionally, right heart catheterization (RHC) was performed before discharge if the consent was obtained.

Results
From May 2021 to May 2023, we analyzed a total of 114 patients (56 in the DAPA group and 58 in the CON group). The mean age was 73 years, 35% were female, and the mean LVEF was 32.5%. There was no significant difference in the incidence of WRF between two groups (16.1% in the DAPA group vs. 12.1% in the CON group, P=0.54, Figure 1). The cumulative loop diuretics dose over 7 days was lower in the DAPA group than CON group (184 ± 9.64 mg vs. 214 ± 9.81 mg, P=0.03, Figure 2). RHC before discharge was performed in 54 patients (96.4%) in the DAPA group and in 54 (93.1%) in the CON group. There were no significant differences in the pulmonary artery wedge pressure, pulmonary artery pressure, right atrial pressure, and cardiac index by the thermodilution method or the Fick method between two groups.

Conclusion
This randomized prospective trial revealed the early initiation of DAPA within 24 hours of admission for ADHF reduced loop diuretic demand without inducing WRF compared to standard decongestive therapy.Figure 1Figure 2
Home alone on milrinone: a novel way to deliver home inotropes as a bridge to heart transplantation
Authors: Easton K , Considine A , Warner V , Downes R , Varghese S , Tong B , Gutman S , Taylor A , Hare J , Leet A , Cheshire C , Bergin P , Kaye D , Patel H 
Published: October 2024

Abstract

Continuous ambulatory intravenous inotropes can be successfully used as a bridge to decision or heart transplant in patients with end-stage heart failure. The traditional model at our institute involved the Hospital in the Home (HITH) team, with daily nurse-led visits to the patients’ home, to safely maintain this treatment, which is otherwise largely restricted to the intensive care setting. In response to the COVID-19 pandemic, delivery of healthcare underwent a paradigm shift. Our model was changed to a patient led continuous intravenous inotrope program at home which obviated the need for a daily nurse visit. We describe our process and our early outcomes.
Fifteen patients were deemed suitable for the Independent at Home program. All patients needed to complete ambulatory intravenous inotrope education, pass competency testing and have implantable cardioverter-defibrillators inserted prior to discharge. Competencies included proficiency for troubleshooting the inotrope ambulatory delivery pump, monitoring of vital signs and ability to report decompensated heart failure symptoms.
Weekly outpatient visits to our heart failure clinic with nursing, medical and pharmacy reviews were scheduled. Emergency action plans were provided to patients.
73.3% of our cohort were male. The average age was 51 years. 46.6% had a diagnosis of dilated cardiomyopathy. 53.3% were listed for heart transplant and were bridge to transplant (BTT) and 46.7% were bridge to decision (BTD) for heart transplant. Over a study period of 35 months, seven (46.7%) patients were weaned off inotropes, three (20.0%) were escalated to durable mechanical circulatory support (one due to decompensated heart failure and two due to persistently elevated pulmonary pressures), four (26.7%) were transplanted and one (6.7%) chose to be palliated. Six patients had one admission, five patients had two admissions. Five readmissions were due to decompensated heart failure, four admissions were planned to optimize pulmonary hypertension following a right heart catheterization, three had peripherally inserted central catheter (PICC) line complications and two had non-cardiac admissions (refer to table 1). The median length of days on the Independent at Home program was 112 days with an interquartile range of 120 days. A comparative group consisting of consecutive patients treated under the previous Hospital in the Home model are presented in table 2; the Independent at Home cohort shows reduced unplanned admissions. The independent at home inotrope program is an effective and safe option to bridge to decision or bridge to cardiac transplantation.HITH vs Independent admission reasonHITH vs Independent admissions
Long-acting CRF2 receptor agonist COR-1389 improves cardiopulmonary function parameters in monocrotaline-induced pulmonary hypertension and right heart failure rat model
Authors: Kowala M C , Guignabert C , Thuillet R , Ottaviani M , Tu L , Ozoux M L , Lawson F C , Janiak P 
Published: October 2024

Abstract

Background
Pulmonary hypertension (PH) associated with right heart failure (RHF) poses a significant therapeutic challenge. Short term studies have shown that urocortin-2 (UCN-2) administration, either intravenously or subcutaneously, can ameliorate cardiac and/or pulmonary parameters in human heart failure (HF) and in animal models of PH and RHF.

Purpose
This study aimed to evaluate the potential benefits of COR-1389, a long-acting CRF2 receptor agonist, on cardiopulmonary function and adverse remodeling in a rat model of monocrotaline (MCT)-induced PH and RHF.

Method
Monocrotaline (40 mg/kg) was administered subcutaneously in rats on Day-0 to induce PH and RHF, while the control group received vehicle. After 14 days, MCT-injected rats were evenly allocated into two groups based on echocardiography parameters of accelerated time/ejection time ratio and tricuspid annular plane systolic excursion (TAPSE), before receiving either COR-1389 (100 ug/kg) or its vehicle subcutaneously every 4 days for 14 days. On Day-28, echocardiography was repeated in all groups, followed by right heart catheterization to directly measure pulmonary hemodynamics. Heart and lung samples were prepared for histological analysis.

Results
By Day-28, MCT-treated rats exhibited significantly elevated mean pulmonary arterial pressure (mPAP) and right ventricular (RV) mass (Fulton Index/BW), along with decreased RV function (increased TAPSE) and reduced cardiac output (CO) compared to control rats. These changes were accompanied by severe tissue remodeling, including increased vascular muscularization (alpha-smooth muscle actin content) and pulmonary arterial wall thickening, RV fibrosis, and cardiomyocyte hypertrophy. Following 14 days of curative treatment, MCT+COR-1389 compared to MCT, significantly decreased mPAP and RV mass (Fulton Index/BW), while RV function improved (reduced TAPSE) and CO was increased. Moreover, COR-1389 attenuated adverse pulmonary vascular remodeling (reduced muscularization and arterial wall thickening), RV fibrosis, and cardiomyocyte hypertrophy, consistent with its hemodynamic effects.

Conclusions
Chronic CRF2 agonism with COR-1389 improved dysregulated cardiac and pulmonary function and structure in the MCT rat model, suggesting its potential for the treatment of PH and RHF.
Treatment with flozins across the whole spectrum of heart failure in Poland between February 2022 and June 2023 based on Heart Failure Observational Study by Polish Cardiac Society.
Authors: Morawiec R , Drozdz J 
Published: October 2024

Abstract

Since the introduction of the ESC guidelines in 2021 and the increased level of recommendations in 2023, SGLT2 inhibitors (SGLT2i) have been widely used in all patients with heart failure (HF), improving their prognosis. Current guidelines recommend the use of SGLT2i across the entire spectrum of HF regardless of ejection fraction.
The aim of the study was to summarize the usage of SGLT2i in patients with HF in Poland, based on data gathered in the Heart Failure Observational Study (HEROES) conducted by the Polish Cardiac Society.
Overall, 1176 patients (enrolled between Feb 2022 and Jun 2023) were included in the analysis (hospitalizations: N=918, outpatient visits: N=258). Most of them were men (71.7%) with a median age of 69 years (IQR: 60-75). Patients with reduced ejection fraction (HFrEF) were the most numerous group (48%, N=565) followed by preserved (HFpEF, 22%, N=259) and mildly reduced (HFmrEF, 14%, N=166) ejection fraction. In 16% of cases, ejection fraction was not reported.
Only fewer than 60% of subjects were reported to be treated with SGLT2i (overall: 59.5%; HFrEF: 82.3%; HFmrEF: 48.8%, HFpEF: 32.4%). We divided the whole study group into 4 even quartiles based on the number of consecutive patients enrolled (Q1: Feb 2022-Dec 2022; Q2: Sep 2022; Q3: Mar 2023; Q4: Jun 2023). Results showed an overall increasing number of patients treated with SGLT2i in consecutive quartiles, especially in HFmrEF group (Fig. 1). However, in the last quartile (Q4), less than 40% usage of SGLT2i in HFpEF patients was observed (38.2%). The analyzed period ended before the release of the 2023 focused update of HF guidelines that strengthened recommendations for SGLT2i use to the first class of recommendations regardless of ejection fraction. This document will probably further increase the usage of SGLT2i in the Polish HF population. Nevertheless, our data are worrying, as overall more than 1/3 of HF patients in the last quartile were not treated with one of the basic and effective drugs in HF. It is worth mentioning that the 2021 HF guidelines recommended SGLT2i in the first class of recommendations only in HFrEF, but by that time, current clinical trial results had already shown great benefit in HFmrEF and HFpEF patients.SGLT2i treatment in PL (Feb2022-Jun2023)