bluuebunny/crossref_metadata_2025_split huggingface dataset:
Body fat or muscle underneath body mass index in heart failure patients: characteristics and prognostic values
Authors: Zhao Z , Kang Y , Chen X , Zhang X , Yang Z , Chen X , Zhang Q 
Published: October 2024

Abstract

Background
Body Mass Index (BMI) has been recognized as a prognosticator for heart failure (HF) in that higher BMI relates to lower mortality. However, limited data are available whether body composition underneath BMI would further differentiate patients with a better or worse outcome, especially in those with lower or normal BMI.

Purpose
To investigate the characteristics of body fat and body muscle in HF patient groups with different BMI, and their impact on prognosis.

Methods
Between July 2021 and July 2022, hospitalized HF patients who were suitable for the examination underwent body composition analysis by using bioelectrical analyses (BIA) in the stable state after decongestion therapy and before discharge. Percentage of body fat (PBF) and percentage of body muscle (PBM) were calculated by dividing the mass of body fat, or body muscle, respectively. Patients were divided into underweight (&lt;18.5kg/m2), normal weight (20-24.9 kg/m2), overweight/obese (≥25kg/m2) based on BMI, who were followed for 180 days for all-cause death.

Results
127 consecutive patients with obtained data were finally enrolled (60±15 years, 70% males), including 20 (15.75%) underweight, 75 (59.06%) normal weight, and 32 (25.19%) overweight/obese. As shown in Table 1, As shown in Table 1, the body fat mass and muscle mass varied with BMI, though they showed a different rate of change. Compared with patients with normal weight, the fat and muscle mass in those overweight/obese was 81.8% and 12.4% higher; whereas it was 39.2%, and 23.1% lower in those underweight, respectively. As results, the overweight/obesity group had a higher PBF, but a lower percentage of PBM. Consequently, the overweight/obesity group had a higher PBF, a lower PBM and a decreased muscle mass/fat mass ratio (MFR); conversely, the underweight group had a lower PBF, a higher PBM and an increased MFR. During 180-day follow-up, 17 (13.4%) died for all cause. By Cox regression analysis, MFR independently predict all-cause death (HR, 1.273, 95% CI: 1.056-1.534, p=0.011) after adjusted for age, BMI, ejection fraction and NT-proBNP. Of note, in patients with normal weight, Receiver Operating Characteristic (ROC) curve analysis suggested the capability of MFR (AUC=0.780, p=0.003) as well as its superiority over BMI in association with all-cause mortality (Figure 1).

Conclusions
The change of body fat or muscle mass with BMI displayed a different rate in HF patients, so that the MFR was higher in underweight but lower in overweight/obese when compared to normal weight group. Apart from BMI, MFR emerged as a predictor of mortality, in particular in patients with normal weight.
Prognostic impact of systemic immune-inflammation index in patients with acute decompensated heart failure with preserved ejection fraction -PURSUIT-HFpEF Registry-
Authors: Kokubu Y , Watanabe T , Yamada T , Seo M , Yano M , Hayashi T , Nakagawa A , Nakagawa Y , Yasumura Y , Sotomi Y , Okada K , Hikoso S , Nakatani D , Fukunami M , Sakata Y 
Published: October 2024

Abstract

Background
Systemic inflammation has been implicated in the pathophysiology of heart failure with preserved ejection fraction. Several studies have shown that systemic immune-inflammation index (SII), a novel index based on platelets, neutrophils, and lymphocytes, predicts poor prognosis in patients with cardiovascular disease. However, it remains to be elucidated whether SII could have predictive value in patients with acute decompensated heart failure with preserved ejection fraction (ADHF-HFpEF).

Purpose
This study is designed to investigate the association of SII at admission or discharge with poor clinical outcome in patients with ADHF-HFpEF.

Methods
Patients’ data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for ADHF-HFpEF in a city. Laboratory data and body weight measurements were performed just before discharge. We analyzed 966 patients (mean age: 81 years old, male: 45%) after exclusion of patients on dialysis, missing follow-up data, or missing data to calculate SII. SII was calculated as follows: SII = platelet count × neutrophil count / lymphocyte count on admission and at discharge. The primary endpoint was the composite of all-cause death and rehospitalization for worsening heart failure.

Results
During a mean follow-up period of 1.8±1.3 years, the primary endpoint was observed in 435 patients (259 patients died and 176 patients underwent rehospitalization for worsening heart failure). In multivariate Cox analysis, high SII at discharge (&gt; 536×109 determined by receiver operating characteristic curve analysis (AUC: 0.564 [0.526-0.602]) was significantly independently associated with not only the primary endpoint (hazard ratio 1.28 [1.04-1.57], p=0.020) but also all-cause death ((hazard ratio 1.39 [1.06-1.81], p=0.018) after adjustment for major confounders such as age, gender, body mass index, NYHA class, systolic blood pressure, heart rate and laboratory data including NT-proBNP and CRP. However, high SII on admission was not significantly associated with primary endpoint after multivariate adjustment. Kaplan-Meier analysis revealed that patients with high SII at discharge had significantly greater risk of both the primary endpoint (56% vs 43%, p&lt;0.001) and all-cause mortality than those with low SII (36% vs 24%, p&lt;0.001).

Conclusion
Systemic immune-inflammation index at discharge, but not on admission, would be associated with post-discharge poor outcome in patients with acute decompensated heart failure with preserved ejection fraction.
The association between circulating B cell count and clinical outcomes in patients with heart failure
Authors: Kobayashi Y , Otaki Y , Watanabe T , Tachibana S , Sato J , Hashimoto N , Wanezaki M , Kutsuzawa D , Kato S , Tamura H , Nishiyama S , Takahashi H , Arimoto T , Watanabe M 
Published: October 2024

Abstract

Background
Despite advances in treatments, heart failure (HF) is still an growing health problem associated with a high mortality rate. In recent years, researchers have increasingly focused on the association between HF and the immune system. However, there have been only a few reports concerning the association between B cells and heart failure. The aim of the present study was to identify alterations in lymphocyte subset counts and examine whether lymphocyte subset counts are associated with clinical outcomes in patients with HF.

Methods and Results
We evaluated lymphocyte subset count, including CD3+ T cells, CD19+ B cells and CD56+ natural killer cells in consecutive 395 patients with HF. All patients were divided into three groups according to CD19+ B cell counts tertiles. First tertile group showed higher inflammation and higher prevalence of malnutrition compared to other groups. There were 79 all-cause deaths and 119 HF-related events during the median follow-up period of 374 days. We found that each lymphocyte subsets decreased with advancing New York Heart Association functional class. The receiver operating characteristics curve analysis demonstrated that the area under the curve of CD19+ B cell count for all-cause mortality was the greatest among lymphocyte subset counts. Kaplan-Meier analysis showed that patients with lowest tertile group had the highest rates of all-cause deaths and HF-related events than in other groups. Multivariate Cox proportional hazard regression analysis demonstrated that CD19+ B cell count was significantly associated with all-cause mortality and HF-related events after adjustment for confounding risk factors.

Conclusion
We for the first time demonstrated that the CD19+ B cell count was significantly associated with severity and clinical outcomes of HF.Kaplan-Meiyer curveforest plot
Comprehensive stress echocardiography uncovers the heterogenity of phenotypes in non-ischemic heart failure with abnormal ejection fraction
Authors: Kalakauskaite L , Karaliute G , Balkeviciene L , Celutkiene J , Ciampi Q , Cortigiani L , Wierzsbowka-Drabik K , Zagatina A , Djordjevic-Dikic A , Manganelli F , Boshchenko A , Borguezan-Daros C , Arbucci R , Pellikka P A , Picano E 
Published: October 2024

Abstract

Background
Heart failure (HF) with abnormal left ventricular (LV) ejection fraction (EF) manifests in multiple phenotypes, each presenting distinct and potentially actionable therapeutic targets. This study aimed to assess the potential of the ABCDE+ stress echocardiography (SE) protocol in uncovering different phenotypes of non-ischemic HF.

Methods
With a retrospective analysis of prospectively acquired data, we identified 265 patients (mean age: 65.7±12.6 years; 154 males, 59.9%) with non-ischemic HF with EF&lt;50% (mean =41.4±7.5) enrolled by 23 certified laboratories between 2021 and 2023. Ischemic origin was excluded based on data of angiography and medical history. ABCDE-SE was evaluated with exercise (n=98, 37.0%), dobutamine (n=50, 18.9%), or vasodilators (n=117, 44.1%). The protocol consisted of several steps: A assessed regional wall motion abnormality (RWMA); B evaluated number of B-lines; C measured left ventricular contractile reserve; Step D with coronary flow velocity reserve (CFVR) in the left anterior descending artery (LAD) was completed in 102 patients (38.5%); step E assessed heart rate reserve. Additionally, step F (evaluated in 188 patients at rest and 107 at peak stress) noted the presence of rest or stress-induced moderate-to-severe secondary mitral regurgitation. The SE response was graded on a scale from 0 (all steps normal) to 5 (all ABCDE+ steps abnormal).

Results
The mean ABCDE score was 1.5±1.2, ranging from 0 (n=59, 22.3%) to 5 (n=2, 0.8%) (see distribution of scores in Figure 1A). Abnormal results were observed in 21 subjects (7.9%) for A, 86 (32.5 %) for B, 147 (55.5%) for C, 42/102 (41.2%) for D, and 101 (38.1%) for E steps. Step F was abnormal in 22/188 (11.8%) at rest and in 16/107 (14.9%) at peak stress. The predominant "solitary phenotypes" (only one step abnormal) were impaired LV contractile function phenotype (step C in 47, 51.1%) followed by chronotropic insufficiency (step E in 17, 18.5%) and congestive phenotype (step B in 17, 18.5%) (see Figure 1B). The most frequent combined phenotype was BCE – congestive phenotype with impaired ventricular and heart rate reserves (28 [62.2%]). Notably, 38 patients (14.3%) demonstrated improved regional contractility, while 27 patients (10.2%) showed new regional wall motion abnormality (see Table).

Conclusion
Non-ischemic HF patients with abnormal EF exhibit a broad spectrum of phenotypes. Impaired left ventricular contractility, interstitial congestion, and chronotropic insufficiency are the most frequent abnormalities detected by ABCDE-SE. Up to one-quarter of such patients demonstrate normal SE results. This comprehensive approach paves the way for personalized, SE-guided therapy.
Right ventricular pulmonary artery uncoupling independently associated with 5 year outcome following AHF hospitalisation
Authors: Berrill M , John I , Fluck D , Sharma P , Baltabaeva A 
Published: October 2024

Abstract

Background
Right ventricular pulmonary artery (RV-PA) uncoupling is associated with poor outcome across a range of conditions, but its role in acute heart failure (AHF) remains incompletely investigated.

Purpose
To investigate if RV-PA uncoupling is independently associated with mortality following hospitalisation for AHF.

Methods
418 patients were recruited. 391/418 (93.5%) had measurable TAPSE and SPAP and were followed up for 5 years to assess for all-cause mortality. Patients were recruited if they displayed signs and symptoms of AHF, had point-of-care brain-natriuretic peptide &gt;100pg/ml and had evidence of HF on TTE. We identified a study-specific cut-off for TAPSE/SPAP of 0.24mm/mmHg on ROC analysis and performed univariate analysis to assess for an association with outcome. 30 covariates encompassing comorbidities, medications, echo parameters and observations were assessed and logistic regression analysis performed including variables associated with outcome.

Results
Patient average age at presentation was 79 years, 53.3% were male, 55.5% had hypertension, 30.7% had diabetes and 36.8% had CAD with a mean LVEF of 42.6% and BNP of 1363pg/ml. The mean TAPSE was 15.6mm and SPAP of 52.5mmHg. The average TAPSE/SPAP was 0.34mm/mmHg. 252/391 (64.5%) presented with TAPSE/SPAP &lt;0.24mm/mmHg. These individuals were at higher risk of 5-year mortality compared to &gt;0.24mm/mmHg: HR 1.94 (95% CI 1.49-2.54 [p&lt;0.0001]), which persisted when adjusted for significant covariates – HR 1.35 (95% CI 1.02-1.80 [p&lt;0.0395]).

Conclusion
TAPSE/SPAP ratio is an independent predictor of mortality in patients admitted with AHF. Our cut-off, a lower value than others have suggested in the literature for chronic conditions such as pulmonary hypertension, could identify those at risk of poor outcome in the acute setting. This may offer an exciting therapeutic target and help risk stratify patients. These results should focus the attention of those managing AHF patients onto the RV, pulmonary pressures and their interrelationship. It is time we moved beyond the LVEF.
Prognostic impact of secondary prevention medical therapy in patients with Takotsubo cardiomyopathy: a Bayesian network meta-analysis
Authors: Zaka A , Mutahar D , Gupta A , Kovoor J , Stretton B , Bacchi S , Mridha N 
Published: October 2024

Abstract

Background
Takotsubo cardiomyopathy (TTC) is a form of transient left ventricular systolic dysfunction without evidence of complicated coronary artery disease. Although initially considered a benign condition, recent studies have demonstrated a significant risk of acute phase complications and a mortality rate between 1-8%. Efficacy of medical therapy in secondary prevention of all-cause mortality and TTC recurrence is not well established. We performed a systematic review and network meta-analysis to evaluate prognostic impact of secondary prevention medical therapy in patients with TTC.

Methods
PubMed, MEDLINE, EMBASE, CENTRAL, and Web of Science were searched up to January 6, 2024. Eligible studies included multivariable-adjusted or propensity matched studies of patients receiving medical therapy with B-blockers (BB), renin–angiotensin–aldosterone system (RAAS) inhibitors, aspirin and statins after an index presentation with TTC. The primary outcome was all-cause mortality at any time point. Secondary outcome was TTC recurrence. Random-effect hierarchical Bayesian meta-analyses was performed.

Results
We identified 15 observational studies. TTC mortality was reported in 435 (4.4%) out of 9735 patients. Mean age was 70.2 ± 4 years and 8858 patients (91.5%) were females. There were no differences in all-cause mortality when comparing BB versus control (OR 0.83; 95% CI 0.47 to 1.47, p=0.52); BB versus RAAS inhibitors (OR 1.03; 95% CI 0.61-1.63), BB versus aspirin (OR 1.02; 95% CI 0.471-2.25) and BB versus statins (OR 0.871; 95% 0.432-1.75). No significant differences were also observed for TTC recurrence.

Conclusion
This network meta-analysis found no significant difference in all-cause mortality or recurrence rates in Takotsubo cardiomyopathy with the use of secondary prevention medical therapies, including beta-blockers, RAAS inhibitors, aspirin, and statins
Combination of diuretics to overcome diuretic resistance in acute heart failure: systematic review and updated network meta-analysis
Authors: Cunha I , Jairo Nunes J T N , Edimar Bocchi E A B 
Published: October 2024

Abstract

Background
Diuretic resistance in acute heart failure (AHF) presents a significant therapeutic challenge. While randomized clinical trials (RCTs) have compared various diuretics against furosemide, direct comparisons among these therapies are lacking. This network meta-analysis aims to fill this knowledge gap.

Purpose
To evaluate the efficacy and safety of various diuretic combination therapies in overcoming diuretic resistance in acute heart failure patients.

Methods
We conducted a systematic review and network meta-analysis of RCTs from January 2000 to December 2023. These RCTs included hospitalized AHF patients with evidence of diuretic resistance. We applied a frequentist random effects model to perform a network meta-analysis combining a total of 11 diuretic strategies compared with low-dose furosemide (reference group). Primary outcomes were urine output and weight loss at 72 hours. Secondary outcomes included cardiovascular mortality and heart failure hospitalization. The safety endpoint was the incidence of acute kidney injury across different diuretic strategies.

Results
Empagliflozin and high-dose furosemide showed the highest increase in urine output (SMDs: 363.94, P-score=0.64; and 306.31, P-score=0.68). For weight loss, hydrochlorothiazide led to the greatest losses (SMD: 1.33; P-score=0.20), followed by tolvaptan + furosemide low-dose (SMD: 0.85; P-score=0.43). Dapagliflozin ranked best for reducing heart failure hospitalizations (OR 0.15; P-score=0.94), and empagliflozin had the highest rank for mortality reduction (OR 0.31; P-score=0.91) but without statistical significance for mortality. Empagliflozin also showed a better safety profile (OR: 0.74; 95% CI: 0.32 to 1.71 P-score=0.87), (Figure 1 and 2).

Conclusion
Our findings indicate that SGLT2 inhibitors are a promising therapeutic avenue to mitigate the challenges of diuretic resistance in AHF, demonstrating potential benefits in enhancing urine output, reducing hospitalization rates, and maintaining favourable safety profile.Network and forest plots for U.O/ weightNetwork and forest plots for HHF/ AKI
Guideline-directed medical therapy titration for heart failure with ischaemic aetiology and its effect on cardiac remodelling and cardiovascular mortality-from a real world perspective
Authors: Bonini J , Zuin M , Vilei F , De Pietri M , Guidi Colombi G , Tezze R , Sarti A , Guardigli G , Fucili A 
Published: October 2024

Abstract

Background
Contemporary Heart Failure (HF) pharmacological treatment has been reshaped by several landmark trials in recent years, and available evidence strongly encourages treatment up-titration to target doses. Recent literature regarding treatment sequencing demonstrated positive effects of up-titration on major outcomes regardless of HF aetiology.

Purpose
We investigated a contemporary Heart Failure with Reduced Ejection Fraction (HFrEF) patient cohort and ischaemic aetiology and sought to understand the effects both in terms of echocardiographic remodelling and upon mortality for cardiovascular (CV) causes of contemporary ESC guideline-directed medical therapy (GDMT) on a real-world level.

Methods
We retrospectively analysed data of consecutive patients with HFrEF and ischaemic genesis followed in our tertiary HF clinic between January 2019 and January 2022. Eligible patients were stratified into two groups: patients treated or not with full doses of ESC GDMT [including angiotensin-converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB) or angiotensin receptor-neprilysin inhibitors (ARNI), beta-blockers, mineralocorticoid receptor antagonists (MRA) and sodium-glucose cotransporter-2 inhibitors (SGLT2i)].

Results
Overall, 203 patients (mean age 70.1±12.3 years, 165 males) were included into the analysis. Over a mean follow-up of 1223±221.2 days, 115 (56.6) patients achieved the full recommended doses of each drug. Patients with an unsuccessful up-titration had higher end-diastolic volume at transthoracic echocardiography (p for difference at first and second follow-up &lt;0.001; figure 1, panel A), lower left ventricular ejection fraction (40.1±4.3% vs 44.3±7.8 and 38.7±4.9% vs 42.3±5.6% at the first and second follow-up, respectively) and higher CV mortality rates compared to those treated with the maximal doses (figure 1, panel B).

Conclusions
Up-titration of pharmacotherapy in our real-world cohort of patients with HFrEF and ischaemic aetiology demonstrated a positive effect both on pivotal echocardiographic parameters and on CV mortality. Our data suggest that timely identification and referral of patients with coronary artery disease who fail to achieve complete positive remodelling after an acute event (or during chronic disease course) for HF contemporary treatment implementation should be envisaged.Figure 1
A personalized, 3D printed, polymeric elastic support device for the prevention of post-MI cardiac remodeling
Authors: Nachman D , Alamore R , Aliev E , Shtraikh S , Horesh A , Rokach Y , Salman S , Abu-Rbo K , Mansour N , Ben Dori E , Cohn D , Amir O 
Published: October 2024

Abstract

Introduction
Myocardial remodeling and dilatation following myocardial infarction (MI) initiates a vicious cycle leading to heart failure (HF). The anatomy and pathophysiology of every patient is unique. We have developed a 3D printed, biopolymer based personalized Elastic Support Device, that is 3D printed based on patient’s imaging, aiming to restore cardiac physiology. This study aimed to assess the device on rat MI model.

Materials and Methods
MI was induced in 24 Sprague Dawley rats by permanently ligating the mid LAD artery via midline sternotomy cut. Twelve animals underwent immediate implantation of the elastic support device that was pre-printed from animal specific 3D echocardiography. The animals were followed up with echocardiography at days -2, 7, 14, 28. The animals were sacrificed at day 28, cardiac tissue and plasma were taken for further histological and biochemical analysis.

Results and discussion
Mortality was similar at both groups (5 vs 4 in the device and control groups respectively). Ejection fraction reduced in both groups from a baseline of 61.9±8.9% to 47.5±12.7%. Left Ventricular End Diastolic Diameter increased from baseline to day 28 in the control (7.0±0.56mm vs 7.7±1mm) but not the device group (6.87±0.2mm vs 6.93±1.1mm, p&lt;0.05). Parameters of diastolic function such as E/E’ were similar in both groups throughout the follow-up. Mason’s Trichrome stained cardiac sections revealed improved infarct size at the device group (7.4±1.9% vs. 10.6±2.8%) and lower overall cardiac fibrosis.

Conclusion
In this preliminary small animal model study, the capability to 3D print and implant an imaging based, personalized, 3D printed elastic support device. The cardiac diastolic function was not impaired, and no safety issues were noticed. Furthermore, cardiac dilatation was prevented, and infarct size was reduced.Trial design and results