bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between liver stiffness and congestive heart failure; analysis of the NHANES 2017 - 2020
Authors: Wattanachayakul P , Rujirachun P , Phichitnitikorn P , Lopimpisuth C , Lalitnithi P , Tantisattamo E 
Published: November 2023

Abstract

Background
Recent studies have shown that liver stiffness is associated with increased cardiovascular events, whether the association between liver stiffness stratified by fibrotic stages and congestive heart failure (CHF) remains unclear.

Methods
We examined a cross-sectional study from the National Health and Nutrition Examination Survey (NHANES) 2017-2020 that included participants ≥18 years old. The association between the degree of liver stiffness classified into four fibrosis scores measured by Fibroscan™ and history of CHF informed by a doctor or other health professional was examined by multiple logistic regression.

Results
We identified 9,700 patients with Fibroscan™

results
The mean ± SD age was 44+/-20 years old, and 49.9% were female. White accounts for 33.7%, followed by Black (26.3%), Mexican American (12.5%), Asian (11.7%), Hispanic (10.1%), and others (5.6%). Among patients with Fibroscan™ results, up to 227 participants (2.8%) had congestive heart failure. Participants were classified into four fibrotic stages, including mild (F0F1), moderate (F2), severe fibrosis (F3), and cirrhosis (F4) of 8,194 (84.5%), 873 (9.0%), 304 (3.1%), and 329 (3.4%), respectively. The risk of CHF among individuals with severe fibrosis (F3) and cirrhosis (F4) was significantly higher compared to individuals with mild fibrosis (F0F1) with the OR of 3.22 and 4.46, respectively (F3: 95%CI 1.99, 5.22, P &lt;0.0001, F4 95%CI 2.97, 6.72, P &lt;0.0001); while the risk of CHF among patient with moderate fibrosis (F2) was 1.20 times as likely to have CHF compared to mild fibrosis(F0F1) but not statistically significant (F2: 95%CI 0.76, 1.90, P 0.411). After adjusting for age, gender, race, BMI, smoking status, high systolic blood pressure (&lt;130 vs.&gt;130 mmHg), and diabetic status, only participants with cirrhosis (F4) were 1.86 times as likely to have CHF compared to those with mild fibrosis (F0F1) (95%CI 1.13, 3.05, P 0.014); However, among participants with moderate(F2) and severe fibrosis(F3), the risk of CHF was 0.77 and 1.34 times respectively but not statistically significant (F2: 95%CI 0.46, 1.26, P 0.304; F3: 0.76, 2.33, P 0.302).

Conclusion
Liver stiffness was positively associated with the likelihood of having CHF. Additional longitudinal studies are required to further evaluate this relationship.
Echocardiographic characterization of patients with supranormal ejection fraction: pooled core laboratory analysis of the TOPCAT and PARAGON-HF trials
Authors: Wang X , Chatur S , Lu H , Claggett B , Skali H , Vaduganathan M , Minamisawa M , Inciardi R M , Shah A M , Packer M , Pitt B , Rouleau J , Pfeffer M A , Mcmurray J J V , Solomon S D 
Published: November 2023

Abstract

Background
Patients with heart failure and supranormal ejection fraction (HFsnEF) may be phenotypically distinct from those with normal or below normal left ventricular ejection fraction (LVEF), and may demonstrate different prognostic trajectories or treatment responses.

Purpose
To characterize clinical features, cardiac structure and function among patients with HF with preserved EF (defined as 45% ≤ LVEF ≤ 65%) and supranormal EF (defined as LVEF&gt;65%).

Methods
Baseline clinical characteristics and key echocardiographic parameters from patients enrolled in the echocardiographic substudies of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist)-Americas and PARAGON-HF (Prospective Comparison of ARNI [angiotensin receptor–neprilysin inhibitor] with ARB [angiotensin-receptor blocker] Global Outcomes in Heart Failure with Preserved Ejection Fraction) were compared between patients with and without HFsnEF.

Results
Among 1,751 participants (mean age 73 years old, 51% women) in this pooled core laboratory analysis, 265 (15%) had HFsnEF. Participants in HFsnEF group were more likely to be women, and less likely to have prior myocardial infarction and atrial fibrillation (Table 1). Compared with those with LVEF ≤ 65%, those with LVEF &gt; 65% had lower LV end-diastolic and end-systolic volume indices, lower LV mass index, higher LV relative wall thickness, and higher right ventricular fractional area change. LV geometry and measures of LV diastolic function were similar in both groups (Table 1). Global longitudinal strain (GLS) was abnormal (absolute GLS &lt;16%) in 28% in those with HFsnEF compared with 53% in those with LVEF ≤ 65%. After adjusting for baseline LV ejection fraction and sex, and stratified by trial, abnormal GLS was associated with a higher risk of composite of first heart failure hospitalization or cardiovascular death (overall hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.23 – 1.98, P &lt; 0.001), cardiovascular death (overall HR 2.06, 95% CI 1.35 – 3.13, P = 0.001), and heart failure hospitalization (overall HR 1.49, 95% CI 1.15 – 1.93, P = 0.003) in both HFsnEF and non-HFsnEF groups (P-interaction &gt; 0.05 for all, Figure 1).

Conclusions
Among participants in the TOPCAT-Americas and PARAGON-HF trials, those with LVEF &gt; 65% were predominantly women, had less LV remodeling, and had better RV function based on echocardiographic measures. Nevertheless, despite supranormal LVEF, GLS was abnormal in over a quarter of patients and remained an important predictor of adverse clinical outcomes in this cohort.Table 1Figure 1
Outcomes of asymptomatic left ventricular dysfunction in the patient with or without type 2 diabetic Mellitus
Authors: Ling L , Sung S H 
Published: November 2023

Abstract

Background
Type 2 diabetes mellitus (T2DM) has been related to ventricular systolic and diastolic dysfunction and subsequent heart failure. [1] The study aimed to investigate the prevalence of asymptomatic left ventricular dysfunction (aLVD) in subjects with T2DM, and its predisposing factors.

Method
Subjects without existed cardiovascular disease were eligible for this study. Left ventricular ejection fraction (LVEF), mitral E/A ratio, peak mitral annulus tissue velocity (e’), left atrial dimension (LAD), peak tricuspid regurgitation velocity (TR Vmax) were obtained by a standard echocardiographic study. Asymptomatic left ventricular diastolic dysfunction (ALVSD) was defined as LVEF &lt; 50% and the asymptomatic left ventricular diastolic dysfunction (ALVDD) was defined as having three or more of the four parameters: septal e' &lt; 7, septal E/e’&gt;15, LAD &gt; 40mm, and TR Vmax &gt; 2.8 m/s. [2] All-cause mortality up to 2 years was obtained by linking to the National Death Registry.

Result
A total of 27684 subjects (59.6±17.4 years, 46.2% men, 17.7% diabetes) were included in this study(Table 1). The ALVSD patients were older, male dominant, more prevalent with hypertension, diabetes mellitus and coronary artery disease, and had higher BMI, lower hemoglobin, and estimated glomerular filtration rate. ALVSD and ALVDD was more prevalent in patients with T2DM than those without (4.9% vs 8.2%, P&lt;0.001)(15.4% v.s. 32.1%) (Figure 1). Age (odds ratio and 95% confidence interval: 1.04, 1.03–1.04), male gender(2.24, 1.99-2.52), T2DM (1.28, 1.11-1.46), coronary artery disease (1.38, 1.14-1.68), hemoglobin (0.95, 0.91-1.00), CKD stage 3(2.02, 1.63-2.50), and CKD stage 4-5(3.95, 3.06-5.09) were all independently correlated to ALVSD(Table 2a). On the other hand age (odds ratio and 95% confidence interval: 1.07, 1.07–1.08), BMI (1.12, 1.11-1.13), T2DM (1.34, 1.24-1.46), hypertension (1.31, 1.20-1.43), hemoglobin (0.88, 0.85-0.91), and CKD stage 4-5(3.11, 2.58-3.76) were independently correlated to ALVDD(Table 2b). During a mean follow-up of 5.3 ± 3.6 years, there were 2625 deaths (9.5%). The Kaplan–Meier curve analysis revealed diabetic subjects with were associated with the worst survival rate than those with either T2DM or ALVSD/ALVDD (Figure 2). The Cox regression analysis revealed the ALVDD and ALVSD was related to mortality, independent of age, gender, body mass index, hypertension, coronary artery disease, hemoglobulin, estimated glomerular filtration rate, and medication [hazard ratio and 95% confidence interval of mortality(ALVSD/ALVDD): 1.78 (1.40–2.25)/1.31(1.15-1.49)].

Conclusion
ALVD has a high disease burden in patients without established cardiovascular disease, and its prevalence is higher in patients with T2DM, which was associated with an excessive mortality rate. Therefore, early screening and intervention should be considered in diabetic patients.
Prognostic impact of a novel risk score for transcatheter edge-to-edge repair in patients with heart failure: sub-analysis of FRAGILE-HF
Authors: Kaneko T , Kagiyama N , Kasai T , Kamiya K , Saito H , Saito K , Maekawa E , Konishi M , Kitai T , Iwata K , Jujo K , Wada H , Momomura S , Matsue Y , Minamino T 
Published: November 2023

Abstract

Background
MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients.

Methods
We calculated MitraScore for 1100 elderly patients (&gt;65 years old) hospitalized for HF in the prospective multicenter FRAGILE-HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all-cause deaths, and the secondary endpoints were the composite of all-cause deaths and HF rehospitalization and cardiovascular deaths.

Results
During a follow-up of two years, 226 all-cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in Kaplan-Meier analysis (p&lt;0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments (adjusted hazard ratio (HR) [95% confidence interval]: 1.22 [1.10-1.36], p&lt;0.001 for all-cause deaths; adjusted HR 1.17 [1.09-1.26], p&lt;0.001 for combined endpoints; and adjusted HR 1.24 [1.10-1.39], p&lt;0.001 for cardiovascular deaths). Hosmer-Lemeshow plot showed good calibration for all endpoints (p = 0.86-0.99). MitraScore resulted in significant reclassification improvements in all-cause and cardiovascular deaths as compared with the GWTG-HF risk score, BIOSTAT compact model, AHEAD and AHEAD-U scores, and HANBAH score.

Conclusion
MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. These results might suggest that HF patients and those receiving TEER shared similar prognostic factors.Kaplan–Meier curves for all-cause deathComparison with other scores
Associations of fasting state glycemic biomarkers with mortality and morbidity in heart failure: Retrospective cohort study
Authors: Iwasaki K , Akagi S , Nakamura K , Ito H 
Published: November 2023

Abstract

Background
Diabetes mellitus (DM) is a common comorbidity among heart failure (HF), complicated with 10% to 47% of HF patients. DM is also known to be associated with cardiovascular mortality and hospitalization for heart failure (HHF) in HFpEF and HFrEF. Though HbA1c is the most used glycemic control target, whether HbA1c is the most appropriate glycemic control marker remains to be investigated.

Purpose
To evaluate relationships between clinical outcomes and glycemic markers among heart failure patients, including HbA1c, HOMA-β and HOMA-IR.

Methods
We retrospectively evaluated the relationships between fasting state glycemic markers, including HbA1c, HOMA-β and HOMA-IR, and clinical outcomes in heart failure patients admitted to our hospital from 2016 to 2020. These glycemic markers were calculated from fasting blood glucose and insulin concentrations. The primary outcome was composite of all cause death or HHF. Multivariate Cox regression proportional hazards models were used to assess the relationship between glycemic markers and clinical outcomes, adjusting for age, sex, DM, BMI, ischemic etiology, eGFR, log-transformed BNP and urgent hospitalization.

Results
682 patients were included in the analyses. Median age was 70 years (IQR 59 to 77 years), and 66% were male. 41% patients had left ventricular ejection fraction below 40%, and 32% had DM. The median follow-up periods were 16.5 months (IQR 4.4 to 37.3 months). HOMA-IR was independently associated with the primary outcome (HOMA-IR 1.0 to 2.5: HR1.34, 95%CI 0.79 to 2.28, p = 0.27; HOMA-IR 2.5 to 10: HR2.19, 95%CI 1.30 to 3.66, p = 0.003; HOMA-IR &gt;10: HR2.92, 95%CI 1.61 to 5.30, p&lt;0.001), but HbA1c and HOMA-β were not associated with the primary outcome (HbA1c 6.0 to 7.0: HR0.99, 95%CI 0.70 to 1.38, p = 0.94; HbA1c 7.0 to 8.0: HR0.80, 95%CI 0.48 to 1.34, p = 0.39; HbA1c &gt;8.0: HR1.02, 95%CI 0.48 to 2.20, p = 0.95; HOMA-β &lt;30: HR0.98, 95%CI 0.64 to 1.51, p = 0.94) (figure 1). Receiver-operator characteristics curve analysis revealed that HOMA-IR (AUC 0.60, 95%CI 0.55 to 0.65) had a significantly better predictive value for the primary outcome compared with HbA1c (AUC 0.56, 95%CI 0.51 to 0.61) and HOMA-β (AUC 0.51, 95%CI 0.46 to 0.56) (Figure 2).

Conclusion
Among fasting state glycemic biomarkers, HOMA-IR was independently associated with mortality and morbidity in HF, but HbA1c and HOMA-β were not. HOMA-IR may aid better DM managements among HF patients beyond current HbA1c targeted DM managements.Adjusted hazard ratio of glycemic markerROC analysis for the primary outcome
Impact of different types of heart failure on coronavirus disease 2019 infection outcomes
Authors: Al-Taweel O , Gill A , Shao R , Wineinger T , Alkhatib D , Ahsan C 
Published: November 2023

Abstract

Background
Pre-existing cardiovascular disease has been associated with increased mortality in patients with coronavirus disease 2019 (COVID-19). However, the impact of different types of heart failure in unvaccinated patients with COVID-19 infection has been understudied.

Purpose
In this study, we compare the in-hospital outcomes of patients with COVID-19 and chronic heart failure with reduced ejection fraction (HFrEF) against patients with COVID-19 and chronic heart failure with preserved ejection fraction (HFpEF).

Methods
This was a retrospective cohort study done by utilizing the 2020 National Inpatient Sample database. We identified patients admitted to the hospital with a principal diagnosis of COVID-19 infection and a secondary diagnosis of either chronic HFrEF or HFpEF. We conducted propensity score matching using a greedy nearest neighbor 1:1 model. Multivariable logistic regression, adjusted for age, sex, hospital characteristics (bed size, location, region), health insurance and comorbidities was used to compare mortality. The comorbidities adjusted for included atrial fibrillation, chronic kidney disease, chronic obstructive pulmonary disease, coronary artery disease, hypertension, obesity, prior myocardial infarction and type 2 diabetes mellitus. The categorical and continuous variables were analyzed by Pearson’s chi-squared and Student t-test respectively.

Results
12,518 patients met our inclusion criteria. Patients with COVID-19 infection and chronic HFrEF had 1.11 times higher odds of suffering in-hospital mortality compared to patients with COVID-19 infection and chronic HFpEF (aOR 1.11, 95% CI: 1.01-1.21; p = 0.03). When separated by race, there was no difference in mortality between our two cohorts (Figure 1). Patients with COVID-19 infection and chronic HFrEF were more likely to have acute hepatic failure (1.2% vs 0.6%, p &lt; 0.001), ventricular tachycardia (6.7% vs 3.1%, p &lt; 0.001) and ventricular fibrillation (0.6% vs 0.2%, p &lt; 0.001), but less likely to have acute respiratory distress syndrome (5.0% vs 6.6%, p &lt; 0.001, Table 1). In terms of comorbidities, patients with both COVID-19 and chronic HFrEF were more likely to have atrial fibrillation (22.8% vs 21.3%, p = 0.03) coronary artery disease (39.5% vs 35.1%, p &lt; 0.001) and prior myocardial infarction (8.8% vs 6.4%, p &lt; 0.001, Table 1). These patients also had shorter hospital stays (8.4 days vs 9.0 days, p &lt; 0.001), but there was no difference in mean total hospital charges ($87,975.84 vs $88,715.96, p = 0.75, Table 1).

Conclusion
Patients with COVID-19 and chronic HFrEF had higher odds of suffering in-hospital mortality compared to patients with COVID-19 and chronic HFpEF. These patients were also more likely to have acute hepatic failure, ventricular tachycardia and ventricular fibrillation. Further studies should investigate how COVID-19 vaccination status influences the outcomes of this vulnerable population.
Prevalence of pulmonary hypertension in mitral regurgitation and its influence on outcomes
Authors: Ratwatte S , Strange G , Stewart S , Playford D , Celermajer D 
Published: November 2023

Abstract

Background
Pulmonary hypertension (PHT) commonly co-exists with significant mitral regurgitation (MR), but its prevalence and prognostic importance has not been well documented.

Purpose
In a large cohort of adults with ≥moderate MR, we aimed to describe the prevalence and severity of PHT and assess its influence on outcomes.

Methods
We analysed the National Echocardiography Database of Australia (data from 2000-2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) &gt;50% and with moderate or greater MR were included (n= 9683). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.2 years, interquartile range 1.3-6.2years).

Results
Subjects were aged 76±12years and 62.6% (6038) were female. Overall, 959 (9.9%) had no PHT; and 2952 (30.5%), 3167 (32.7%), 1588(16.4%) and 1017 (10.5%) patients had borderline, mild, moderate and severe PHT respectively. A "typical left heart disease" phenotype was identified with worsening PHT, showing rising E:e’, right and left atrial sizes increasing progressively, from no PHT to severe PHT (p&lt;0.0001, for all). With increasing PHT severity, 1- and 5-year actuarial mortality increased from 8.5% and 39.7%, and from to 33.0% and 79.8% respectively (p&lt;0.0001). Similarly, adjusted survival analysis showed the risk of long-term mortality progressively increased with higher eRVSP levels (adjusted hazard ratio (aHR) 1.20, 95% confidence interval 1.04-1.38 in borderline PHT, to aHR2.86, 95%CI 2.48-3.31 in severe PHT, p&lt;0.0001) (Figure 1). A mortality inflection was apparent at an eRVSP level &gt;34.00mmHg (HR1.27, CI1.00-1.36) (Figure 2).

Conclusions
In this large study we characterise the close but incompletely understood relationship between significant MR and complicating PHT. Mortality increases as PHT becomes more severe from an eRVSP of approximately 34mmHg onwards.Adjusted Risk for All-Cause MortalityThreshold for Mortality
Long-term outcomes of patients with tachycardia-induced cardiomyopathy
Authors: Serban T , Weidlich S , Pfister O , Kuehne M , Sticherling C , Badertscher P 
Published: November 2023

Abstract

Introduction
Tachycardia-induced cardiomyopathy (TCM) is a reversible type of heart failure that occurs after sustained tachyarrhythmia. TCM can occur on its own (pure TCM) or superimposed on another type of CM (impure TCM). Survival data for such patients are lacking.

Purpose
We aimed to compare the 5-year survival rates of pure and impure TCM patients compared to other types of CM.

Methods
We retrospectively identified patients with reduced ejection fraction (≤50%) and/or atrial fibrillation or flutter with a left ventricular ejection fraction (LVEF) that improved from baseline (≥ 15% in LVEF at follow-up (FU)) through retrospective chart review. Patients were then divided into four groups (pure TCM, impure TCM, ischemic CM and nonischemic CM). The primary outcome was defined as a composite of death, life-threatening arrhythmia or cardiogenic shock. Secondary outcome was cardiovascular re-admission during FU.

Results
238 patients were included (mean age 68 ± 12 years, 31% women). Patients were classified as pure TCM in 35%, impure TCM in 18%, ischemic CM in 24% and non-ischemic CM in 23%. Median FU was 5 (IQR 4-6) years. 13 (5.5%) patients reached the composite outcome at FU. While patients with pure TCM showed similar survival rates as patients with ischemic or nonischemic CM (Figure), a significant difference in survival was observed between impure CM and ischemic and non-ischemic CM with respect to the composite outcome (11% vs 2.7%, p = 0.024). Patients with impure CM showed comparable rates of cardiovascular re-admission during FU compared to patients with ischemic and non-ischemic CM (45% vs. 49%, p = 0.91).

Conclusions
TCM patients have survival rates similar to patients with another type of CM. Patients with TCM on top of a non-ischemic or ischemic CM (impure TCM) demonstrated the lowest 5-year survival rates. Early detection and treatment of cardiac arrhythmias in patients with impure TCM seem to be warranted.Figure
Incorporating hypochloremia provides additive prognostic information in hospitalized patients with heart failure
Authors: Misumi K , Matsue Y , Nogi K , Kitai T , Oishi S , Suzuki S , Yamamoto M , Kida K , Okumura T , Nogi M , Ishihara S , Ueda T , Kawakami R , Saito Y , Minamino T 
Published: November 2023

Abstract

Background
Although hypochloremia has been suggested as a strong marker of mortality in hospitalized patients with heart failure (HF), it has not been clarified whether incorporating hypochloremia into pre-existing prognostic model improves the model performance to predict long-term mortality in patients with chronic heart failure.

Purpose
The aim of this study is to develop a novel risk model which adds hypochloremia as a component into the pre-existing risk model and identify whether the model performance has improved its performance or not.

Methods
We calculated the pre-existing modified Get-With-the-Guideline®risk score(GWTG-RS) which is composed of GWTG risk score + anemia + NYHA + log-BNP, and also developed a new risk score adding hypochloremia into the modified GWTG-RS in patients enrolled in REALITY-AHF or NARA-HF. Hypochloremia was defined as &lt; 97 mmol/L. The validation and comparison of the model performance were performed in two large scale heart failure cohorts. All models were tested for one-year mortality.

Results
We tested the prognostic value of hypochloremia measured at the time of discharge in 2,496 hospitalized patients with HF registered to REALITY-AHF or NARA-HF. Patients with hypochloremia were strongly associated with one-year mortality compared to those without (Log-rank: p&lt;0.001), and this association was retained even after adjustment for GWTG-RS variables, anemia, NYHA and log-BNP (HR 1.64; p&lt;0.001). Next, we tested whether adding hypochloremia to the prediction model comprised of the modified GWTG-RS improves its performance, and it yields numerically larger area under the curve (0.740 vs. 0.749; p = 0.059) and significant improvement in net-reclassification (0.159; p = 0.010).

Conclusions
Presence or absence of hypochloremia at discharge provides incremental prognostic information on top of pre-existing risk prediction model in hospitalized patients with HF.Kaplan-Meier curves for 1-year survival