bluuebunny/crossref_metadata_2025_split huggingface dataset:
Re-classification of response to cardiac resynchronization therapy: the long-term effect of echocardiographic non-progression
Authors: Behon A , Merkel E D , Schwertner W R , Kuthi L K , Veres B , Masszi R , Osztheimer I , Zima E , Geller L , Kosztin A , Merkely B 
Published: May 2024

Abstract

Introduction
Approximately one-third of patients undergoing cardiac resynchronization therapy (CRT) implantation fail to show echocardiographic improvement and are categorized as non-responders, despite of probable beneficial clinical response.

Purpose
We aimed to evaluate the long-term outcome of CRT patients by their echocardiographic response outsorting those with unchanged parameters.

Methods
Altogether 1019 patients undergoing CRT implantation between 2000-2020 in our center were analyzed retrospectively. Patients were grouped by their echocardiographic response defined as LVEF change upto12 months: super-responders ≥20% (n=113), responders 6-19% (n=448), non-progressors 0-5% (n=244), and progressors &lt;0% (n=214). The primary endpoint was the composite of all-cause mortality, heart transplantation, or left ventricular assist device implantation.

Results
During the median follow-up time of 4.7 years 547 (54%) patients died, 35 (31%) super-responders, 223 (50%) responders, 133 (55%) non-progressors, and 156 (73%) progressors. The mean change in LVEF occurred as follows: super-responders 24.5% ± 4.1%, responders 11.5% ± 3.8%, non-progressors 2.8% ± 1.8%, and progressors -6.6% ± 4.5% (p&lt;0.001). Univariate Cox regression analysis revealed that non-progressors had a similar outcome to responders (HR 1.17; 95%CI 0.94-1.45; p=0.15) and a superior outcome to progressors (HR 0.60; 95%CI 0.48-0.76; p&lt;0.001), which was also confirmed by multivariate analysis: non-progressors vs. responders (HR 1.25; 95%CI 0.98-1.58; p=0.07) and non-progressors vs. progressors (HR 0.62; 95%CI 0.47-0.80; p&lt;0.001).

Conclusion
In our current analysis, non-progressors had a superior outcome to progressors suggesting that CRT moderates the remodeling process. These findings indicate their selection and the re-classification of CRT response by echocardiographic changes.Survival by responseMean change in LVEF by response
Patient satisfaction followed by remote monitoring
Authors: Mendez Zurita F , Grande Osorio M , Majo Ramirez D , Rodriguez Font E , Alonso Martin C , Guerra Ramos J , Moreno Weidmann Z , Campos Garcia B , Gilces Bravo E , Ybarra Falcon C , Ramirez De Diego I , Sanchez Martin L , Lucero Calabuig P , Vinolas Prat X 
Published: May 2024

Abstract

Introduction
Remote monitoring (RM) of cardiac implantable electronic devices has increased significantly in the last years. The safety and efficacy of RM have been demonstrated, however, there are few data on patient satisfaction. The objective of this study was to evaluate the satisfaction of patients with an implanted pacemaker (PM) followed through remote monitoring.

Methods
Patients implanted with a conventional or leadless PM who had been using RM system for at least 3 months were included. Patients had to be able to understand and answer questionnaires, having no significant cognitive impairment. An specific, and previous validate, patient satisfaction RM questionnaire with 30-item, self-completed, measured on a 5-point Likert scale (0=No, nothing, 4=Yes, a lot) was administered. The questionnaire is structured in 5 dimensions: Information on cardiac condition, device convenience, transmission process, satisfaction with medical monitoring, and benefits. The results are presented as mean. The difference between mean was analyzed using the T-Student test.

Results
A total of 98 patients were included (77.8±8.2 years old, 67% male), 82 % had conventional PM and 18 % leadless PM. According RM connectivity 70% had daily automatic transmission, 12% automatic transmission and 18% manual transmission. On average, participants answered 83% of the items. The overall satisfaction of the patient was high (3.66). The mean score for each dimension is summarized in Table 1. The Device convenience had the highest mean (3.75), and the Transmission process had the lowest mean (3.56). There was no difference between patients with a conventional pacemaker versus leadless pacemakers (Fig 1, p=0,30).

Results
Patients with PM followed through RM have a high level of satisfaction when evaluated using an specific questionnaire. The level of satisfaction is independent of the type of PM or the connectivity of the system.Table 1Mean dimension score by device type
Early relevant alerts from remote monitoring in heart failure patients with a cardiac implanted electronic device: what implications for long term outcome?
Authors: Mei D A , Imberti J F , Sbarra F , Serafini K , Mantovani M , Leo G , Cherubini B , Gerra L , Vitolo M , Bonini N , Mauro E , Turco V , Casali E , Boriani G 
Published: May 2024

Abstract

Background
Alarms generated by remote monitoring (RM) of cardiac implantable electronic devices (CIEDs) have been associated with worse clinical outcomes in patients with heart failure (HF). However, whether the timing of RM alerts impact on the clinical trajectories of HF patients is still debated.

Purpose
To examine the impact of alerts occurring in the first 180 days after CIED implant on clinical outcomes, as well as potential predictors.

Methods
we retrospectively enrolled all patients with a history of HF implanted with a CRT-D or an ICD at our tertiary. We collected data regarding ATP, shock and HF score above threshold (defined as multiparametric scores provided and validated by all CIED manufacturers). We defined early relevant alerts (Early-RA) as alarms received during the first 180 days after implant. The primary clinical outcome of the study was a composite of death or HF hospitalization. Logistic and Cox regression analyses were used to determine associations. The occurrence of early-RA was used as a time dependent covariate.

Results
A total of 272 patients were included in the analysis (median age 67.4 years, IQR 58.6-74.6, 19.9% female). Twenty patients had an early-RA (7.3% of the overall study population) and were found to be older, more severely symptomatic for HF, with a higher prevalence of atrial fibrillation (AF) and chronic kidney disease (CKD) (all p values&lt;0.05). On the other hand, HF etiology and prevalence of CRT-D did not differ between the two groups.
At univariate logistic regression analysis, we found the following factors as significantly associated with early-RA: age (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.00-1.10), NYHA class (OR 2.44, 95% CI 1.01-5.82) and CKD (OR 3.41, 95% CI 1.21-8.98), but these results were not confirmed at the multivariable logistic regression.
After a median follow-up of 959 days (IQR 432-1484), patients reporting an early-RA had more primary outcome events (45.0% vs 12.3% p&lt;0.001). At time-dependent multivariable Cox regression analysis adjusted for age, sex, left ventricular ejection fraction and type of CIED, we found that early-RA were independently associated with a higher risk of the primary outcome (hazard ratio [HR] 3.61, 95%CI 1.42-9.18) (Figure). Early-RA were also associated with a higher risk of death (HR 5.58, 95% CI 1.68-18.50) while no significant association was found for HF hospitalization (HR 2.46, 95% CI 0.80-7.57, p=0.116).

Conclusions
The occurrence of alerts detected by RM of CIEDs in a relatively early phase (within 180 days from implant), is associated with a higher risk of a composite of death and HF hospitalization in HF patients.Study Outcome according to Early RATime dependent Cox regression
Lead break during extraction - predisposing factors and impact on procedure complexity and outcome on the basis of analysis of 3825 procedures
Authors: Kutarski A , Jachec W , Czajkowski M , Stefanczyk P , Kosior J , Nowosielecka D , Tulecki L 
Published: May 2024

Abstract

Background
There are no reports describing lead break (LB) during transvenous lead extraction (TLE). Our aim was to compare the effectiveness of different approaches and tools used for LB removal during 127 procedures.

Methods
Retrospective analysis of 3825 consecutive TLEs using mechanical sheaths.

Results
Fracture of the lead defined as LB with a long lead fragment (LF) occurred in 2.48%, LB with a short LF in 1.20%, LB with the tip of the lead in 1.78% and LB with loss of a free-floating LF in 0.57% of cases. In total, extractions with LB occurred in 6.04%. In cases in which lead remnant was equivalent to a lead fragment (more than the lead tip only) there was a 50.31% chance of removing the LF in its entirety and an 18.41% chance of significantly reducing its length (to less than 4 cm). Risk factors for LB are similar to those for major complications and increased procedure complexity: long lead dwell time [OR=1.018], higher LV ejection fraction, multiple previous CIED-related procedures and extraction of passive fixation leads. A superior approach was the most popular (75.59%), femoral (15.75%) and combined (8.66%) approaches were the least common. Broken lead fragments (BLFs) were removed in their entirety in 63.78% and BLF length was significantly reduced (to less than 4 cm) in 24.41%. The best results were achieved when BLFs were longer (&gt;4 cm) (66.67%), either free-floating or in the pulmonary circulation (68.42%) but not in cases of short BLFs (20.0%). Complete procedural success was achieved in 70.87% of procedures, the lead tip retained in the heart wall and short BLFs were found in 25.98%, whereas BLFs &gt; 4 cm were left in place in 3.15% of procedures only. There was no relationship between approach in lead remnant removal and long-term mortality. All forms of LB were associated with increased procedure complexity and major complications (9.96% and 1.53%). There was no procedure-related death among such patients and LB did not affect survival after TLE.

Conclusions
1. LB during TLE occurs in 6.04% of procedures and it increases procedure complexity and risk of major complications. Thus, the possibility of LB should be taken into account when planning lead extraction strategy and training. 2. Effectiveness of fractured lead removal is satisfactory. 3.Risk factors for lead fracture are implant duration (16.27 years on average), ventricular leads (71.65%), passive fixation leads (97.63%) and pacemaker leads (92.13%), but not ICD leads (only 7.87% of lead fractures). 4. Broken lead removal using a coronary sinus access sheath as a "subclavian workstation" for continuation of dilatation with conventional tools deserves attention.
LECOM (Lead Extraction COMplexity): a new scoring system for prediction of a difficult procedure
Authors: Jachec W , Nowosielecka D , Ziaja B , Polewczyk A , Kutarski A 
Published: May 2024

Abstract

Background
Transvenous lead extraction (TLE) can become far more complex when unanticipated difficulties arise.

Aim
The aim of this study was to develop a simple scoring system that allows prediction of difficulty and complexity of this important procedure.

Methods
Based on a retrospective analysis of 3741 extraction procedures (extended fluoroscopy time, need for second-line instruments, and advanced techniques and instruments), a 5-point Complex Indicator of Difficulty of T(LE) Procedure (CID-TLEP) scale was developed. Two or more points on the CID-TLEP scale indicated a higher level of procedure complexity.

Results
Multivariate regression analysis showed that patient age below 51 years at first CIED implantation, number of abandoned leads, number of previous CIED-related procedures, passive fixation leads to be extracted, multiple leads to be extracted, and a ratio of dwell time of oldest extracted lead to patient age during TLE of &gt;0.13 are significant predictors of higher levels of lead extraction complexity. The ROC analysis demonstrated that the total number of points (the sum of the odds ratios of the above variables) of &gt;9.697 indicated a 21.83% higher probability of complex TLE (sensitivity 74.08%, specificity 74.46%). Finally, the logistic function model was employed, and a simple equation for Lead Extraction COMplexity was constructed to predict the probability of a difficult procedure. The risk of complex extraction (in percentage) was calculated as [1/(1 + 55.34·0.754X)]·100 (P &lt; 0.001).

Conclusion
(1) The LECOM score can effectively predict the risk of a difficult transvenous lead extraction procedure, and (2) Predicting the probability of a more complex procedure may help clinicians in planning lead removal and improving patient management. (3) Simple on-line calculator should be available to predict a difficulty of planned TLE procedure and to allow to send more demanding patient to more experienced high-volume centre.
Low serum irisin levels predicted newly atrial fibrillation in patients with any phenotypes of chronic heart failure
Authors: Berezin A E , Lichtenauer M , Hoppe U , Berezina T A , Obradovic Z , Berezin O O 
Published: May 2024

Abstract

Background
Atrial fibrillation (AF) continues to be a major health problem among patients with known cardiovascular disease including heart failure (HF). AF is not only powerful risk factor for newly HF, but also it contributes to untoward clinical course of the condition. Although, natriuretic peptides are well-validated biomarkers to predict poor clinical outcomes of HF, their accuracy for AF in patients with different phenotypes of HF is not optimal. Recent studies showed that adipocytokines including irisin affect the risk of AF occurrence. We hypothesized that serum irisin can have additional discriminative potency for AF among HF in patients.

Methods
The study group comprised 541 consecutive patients with chronic HF aged 41 to 76 years recruited for the study from October 2020 to December 2022. We included 153 patients with any phenotypes of HF who were hospitalized due to paroxysmal or persistent AF and a control group of 388 age- and sex-matched individuals admitted to hospitals due to exacerbation of HF. All patients included in the study were examined by conventional general clinical and physical investigations, B-mode echocardiography and Doppler. The plasma levels N-terminal-natriuretic pro-peptide (NT-proBNP), high sensitivity (hs) C-reactive protein, tumor necrosis factor-alpha (TNF-alpha), hs-troponin T, adropin, apelin, leptin, adiponectin, and irisin were measured using ELISA.

Results
Compared with patients from control groups, patients with AF had greater left atrial volume index (LAVI), higher serum levels of NT-proBNP, hs-CRP, TNF-alpha, and lower left ventricular ejection fraction (LVEF), irisin and apelin levels. There were no significant difference between groups in left ventricular mass index, the serum levels of hs-troponin T, adropin, leptin, and adiponectin. Multivariate linear regression adjusted to LVEF and LAVI revealed that irisin and NT-proBNP were the predictors for AF. We found that the well-balanced cut-off point for serum concentration of irisin (AF versus non-AF) were 10.5 ng/mL (area under curve [AUC] = 0.96, sensitivity = 81.0%, specificity = 88.0%; P = 0.0001). Cutoff point of NT-proBNP that distinguished patients with AF and without AF was 750 pmol/L (AUC = 0.96; sensitivity = 72.7%, specificity 76.5%, р = 0.0001). Multivariate Cox regression model yielded that the serum levels of irisin &lt; 10.5 ng/mL (odds ratio [OR] = 1.40; P = 0.001) and NT-proBNP &gt; 750 pmol/mL (OR = 1.22; P = 0.012), LAVI &gt; 34 mL/m2 (OR = 1.06; P = 0.010) remained to be strong predictors for newly AF. Add-on of irisin &lt; 10.5 ng/mL to the predictive model constructed from NT-proBNP (&gt; 750 pg/mL) significantly improved discriminatory potency of the whole model for HF.

Conclusion
We found that decreased serum levels of irisin significantly predicted newly AF in patients with any phenotypes of HF.
Risk factor profile and outcomes in young patients presenting with acute ST-segment elevation myocardial Infarction
Authors: Qayoom R , Naseer A , Khokhar M I , Aijaz S , Hanif B 
Published: May 2024

Abstract

Introduction
ST-elevation myocardial infarction (STEMI) is more prevalent in the elderly population1, but is now becoming more common in the younger population. It has been of particular concern due to its potential for premature death and long-term morbidity. Early identification and timely modification of risk factors in this population is critical2,3. Secondary prevention issues in populations are well studied, and such data for young adults are lacking in the literature.

Purpose
The purpose of this study was to compare pattern of traditional CVD risk factors, hospital mortality and major adverse cardiac events at discharge in young versus old patients (≤45years and above 45 years age respectively) admitted with STEMI and undergoing primary PCI.

Methods
This retrospective cohort study was conducted on consecutive patients presenting with STEMI between June 2013 and June 2018 in a single centre cardiac only tertiary care setup. Institute’s registry is fashioned along and is affiliated with US NCDR. Patients with cardiac arrest or cardiogenic shock at arrival were excluded. MACE was defined as post PCI cardiac arrest or cardiogenic shock, heart failure, major bleed or hospital death.

Results
Total of 5343 patients were admitted with STEMI during study period, after exclusion data of 1642 patients were analyzed.
Table 1 demonstrates demographic and historical characteristics of the study population. Among young patients, the frequency of the male gender,any tobacco use and family history of premature coronary artery disease were significantly higher (all p values &lt; 0.001). While in older STEMI patients frequency of heart failure, hypertension, prior myocardial infarction, diabetes mellitus ,abnormal creatinine clearance (&lt;90 mL/min/1.73 m²) , multi-vessel coronary disease, advanced Killip class and higher body mass index was more prevalent (all P&lt;0.001).
Table 2 demonstrates predictors of in hospital death and MACE. Among young patients advanced Killip class and femoral access site(all P values &lt;0.001), diabetes mellitus (p=0.03), abnormal creatinine clearance(p=0.04),and left ventricular ejection fraction less than 40%(p=0.01), were more significant in-hospital mortality predictor where as advanced Killip class,Left ventricular ejection fraction less than 40% male gender(p=0.04), diabetes mellitus(p=0.001),femoral access site(p=0.001), and Left ventricular ejection fraction less than 40% were more significant MACE predictors (all P&lt;0.001).

Conclusion
There were no significant difference in hospital mortality and MACE among young versus old STEMI patients when adjusted for diabetes mellitus, abnormal creatinine clearance (&lt;90 mL/min/1.73 m²), multi-vessel coronary disease, advanced Killip class. Tobacco use is the main modifiable risk factors for young patients with STEMI. Surprisingly, being a woman and having a positive family history with premature coronary artery disease were protective.
Changes in public interest in sudden cardiac arrest: a big data analysis
Authors: Han J , Baykaner T 
Published: May 2024

Abstract

Background
Search engine queries (SEQ) are considered a surrogate for public interest, with the most popular global search engine processing ~ 1.2 trillion online queries annually and &gt;1 billion health-related queries daily.1 Big data from SEQ trends have been used for disease surveillance and may be able to offer insights for public health interventions, such as detecting respiratory illness outbreaks and understanding cardiac disease patterns.2-4 Sudden cardiac arrest (SCA) occurs in ~5 million people annually worldwide; October is internationally designated for SCA awareness, with public health campaigns aimed to improve early recognition of and early defibrillation for SCA. Use of big data from SEQ as a public health tool to assess changes in public interest surrounding SCA campaigns has not been explored.

Purpose
To characterize changes in public interest in SCA via analysis of internet SEQ trends.

Methods
Google Trends was queried for the terms "cardiac arrest", "cardiopulmonary resuscitation" (CPR), "automated external defibrillation" (AED) and "myocardial infarction" (MI) worldwide for the past 5 years (11/2018 – 11/2023). Relative search volumes (RSV, expressed in scale from 0-100) and related queries were analyzed. Baseline RSV for each term was defined as 2 weeks pre-peak. Numerical percentage and Chi square tests were used for statistical comparison.

Results
Compared to baseline, RSV for "cardiac arrest" significantly increased in correlation with the SCA of 2 professional athletes: Christian Eriksen (football, Denmark) on 6/12/2021 (+321%, p&lt;0.001), Damar Hamlin (American football, United States) on 1/2/2023 (+653%, p&lt;0.001) and collegiate athlete Bronny James (basketball, United States) on 7/24/2023 (+164%, p&lt;0.001). (Figure) RSV significantly increased for "cardiopulmonary resuscitation" (+61% and +170% respectively, p&lt;0.001 for both) and "Automated external defibrillator" (+141% and +192% p&lt;0.001 and p=0.003, respectively) during the same period for pro-athletes but not for the college athlete (p=1.0 and p= 0.84 respectively). While none of the athletes had MI, RSV for "myocardial infarction" also had correlating increases over baseline for all 3 athletes (+35%, p&lt;0.001 +30%, p&lt;0.001 and +22%, p=0.027, respectively). RSV did not significantly change for any search terms during October SCA awareness months during the study period (all p&gt;0.05).

Conclusions
Public interest in SCA, CPR and AED surge when SCA occurs in well-known individuals such as athletes, rather than with scheduled public health campaigns; co-surge in MI interest likely indicates on-going public confusion between SCA and MI. Analyses of big data from SEQ could assist cardiovascular societies in planning targeted SCA educational campaigns by building upon periodic natural surges in public interest in SCA, CPR and AED; this should include continued education on the differences in recognition and treatment of SCA and MI.
Genetic, sociodemographic, lifestyle, and clinical risk factors of heart failure aggravation events: data from the UK Biobank
Authors: Hwang T , Yang P , Jang E , Choi S , Kim D , Yu H , Kim T , Uhm J , Song J , Pak H , Lee M , Joung B 
Published: May 2024

Abstract

Background
Heart failure (HF) is the leading cause of readmission and hospitalization.

Purpose
This study examined the associations and clinical utilities of genetic, sociodemographic, lifestyle, laboratory, and clinical risk factors on HF aggravation.

Methods
Data were from 5,345 UK Biobank middle-aged adults with established HF at enrolment. We performed Cox proportional hazard regression analyses to investigate the associations related to HF admission after enrolment utilizing 24 variables encompassing sociodemographic, clinical, lifestyle, and laboratory data. To assess the impact of genetic factors, we additionally adjusted each polygenic risk score (PRS) for the three medical histories: hypertension, atrial fibrillation (AF), and coronary heart disease (CHD), where the hazard ratios were statistically significant.

Results
Over a median follow-up of 11.5 [10.9-12.2] years, 247 (4.6%) HF admission events occurred. Among the 24 variables, statistically significant hazard ratios were observed for 10 variables, with hypertension (3.31, 2.19-5.02), AF (2.06, 1.53-2.75), current smoking (1.63, 1.09-2.46), and coronary heart disease (1.58, 1.17-2.13) showing the highest hazard ratios, while female gender (0.65, 0.46-0.91) exhibited the smallest hazard ratio. After adjusting for each PRS individually, HTN PRS (HR 1.06, 0.94-1.21) and AF PRS (HR 1.02, 0.90-1.16) were not statistically significant, whereas CHD PRS (HR 1.15, 1.02-1.31) showed significance in relation to HF admission. In the HF admission prediction model, the C index was 0.859 (0.838-0.880) with clinical variables, and it marginally increased to 0.864 (0.843-0.885) when all factors, including the genetic factor, were applied.

Conclusions
Sociodemographic, clinical, laboratory, lifestyle, and genetic factors are each associated with HF aggravation with male gender, hypertension, AF, low eGFR, cigarette smoking, and CHD PRS.