bluuebunny/crossref_metadata_2025_split huggingface dataset:
Efficacy of implantable cardioverter-defibrillator in non-ischemic systolic heart failure in patients with and without chronic kidney disease: an extended follow-up analysis of the DANISH trial
Authors: Doi S N , Butt J H , Thune J J , Nielsen J C , Haarbo J , Yafasova A , Bruun N E , Gustafsson F , Eiskjaer H , Hassager C , Svendsen J H , Hofsten D E , Torp-Pedersen C , Pehrson S , Kober L 
Published: November 2023

Abstract

Background
Patients with heart failure (HF) and chronic kidney disease (CKD) may have an increased risk of death from causes competing with arrhythmic death, which could have implications for the efficacy of implantable cardioverter defibrillators (ICDs).

Purpose
In this extended follow-up study of the Danish Study to Assess the Efficacy of primary prevention of Implantable Cardioverter Defibrillators in Patients with Non-ischemic Systolic Heart failure on Mortality (DANISH), adding four years of additional follow-up, we examined the long-term effects of primary-prevention ICD implantation, compared with usual medical care, according to baseline CKD status.

Methods
In the DANISH trial, 1,116 patients with non-ischemic systolic HF were randomized to receive an ICD (N=556) or usual care (N=550). Outcomes were analyzed according to CKD status (eGFR ≥/&lt; 60 mL/min/1.73 m2) at baseline. The primary outcome was death from any cause. Secondary outcomes were cardiovascular death and sudden cardiovascular death.

Results
In total, 1,113 patients had an available eGFR measurement at baseline (median eGFR 73 ml/min/1.73 m2), and 316 (28%) had CKD. During a median follow-up of 9.5 years, ICD implantation, compared with usual medical care, did not reduce the rate of death from any cause (no CKD, HR 0.81 [95% CI, 0.64-1.03]; CKD, HR 0.92 [0.68-1.26]; P for interaction=0.31) or cardiovascular death (no CKD, HR 0.76 [0.57-1.02]; CKD, HR 0.95 [0.66-1.36]; P for interaction=0.21), irrespective of baseline CKD status. Similarly, baseline CKD status did not modify the beneficial effects of ICD implantation on sudden cardiovascular death (no CKD, HR 0.57 [0.32-1.00]; CKD, HR 0.60 [0.31-1.14]; P for interaction=0.70).

Conclusions
Primary-prevention ICD implantation did not provide an overall survival benefit regardless of baseline kidney function in patients with non-ischemic systolic heart failure.Figure
QRS width variation as a marker of prognosis after CRT implantation: getting slimmer is getting better
Authors: Ferreira D , Brito J , Silva P A , Antonio P S , Pereira S C , Silva B V , Oliveira C , Garcia B , Martins A M , Raposo P M , Gregorio C , Fonseca J , Abrantes A , Vilela M , Cravo J 
Published: November 2023

Abstract

Introduction
Cardiac resynchronization therapy (CRT) is a major therapeutic tool in the management of patients with systolic heart failure. However, controversy remains regarding who will most benefit from this device. The aim of the present study was to evaluate the impact of QRS duration on echocardiographic response and clinical outcomes.

Methods
We conducted a retrospective, observational, single-center study of patients submitted to CRT implantation. Only patients with electro and echocardiographic data on baseline and follow-up were included. CRT response was defined as an improvement of LVEF &gt;10% or LVESV&gt;5%. CRT superresponse was defined as an improvement of LVEF above the population 4th quartile (18%). Impact of QRS variables on CRT response was evaluated with ROC curve analysis. Clinical outcomes were defined as hospitalizations due to heart failure and all-cause mortality. Impact of QRS on clinical endpoints, response and superresponse was evaluated with survival analysis.

Results
From a total of 654 pts a total of 245 fulfilled the inclusion criteria. (57,3%% female, mean age). Most of the pts had a non-ischemic etiology (61,5%) and atrial fibrillation was present in 29.4%. The QRS characteristics were the following, baseline: 162+21ms, follow-up 159+28ms, mean QRS variation: 3+29ms. CRT response occurred in 69% of the pts and superresponse in 26%.
QRS variation is the best predictor of CRT response (AUC =0,66, 95%CI 0,58-0,74, p&lt;0,001). Interestingly, a QRS reduction above 8ms presented the best accuracy (S:70%;E:57%) for response to CRT. On multivariate analysis, after adjustment for gender, atrial fibrillation and cardiopathy etiology, only a QRS reduction above 8ms (p 0.028, HR 1.974 CI (1.075-3.623) and lower baseline LVEF (p = 0.02, 95% CI 0.943 (0.909-0.979) were significant independent predictors of CRT superresponse.
Additionally, a QRS reduction higher than 8ms was a protective factor for long-term clinical outcomes during follow-up (p&lt;0.001 HR (2,445) 1,553 a 3,849) – fig.1.

Conclusion
In pts with implanted CRT a reduction in QRS width, as small as 8ms, its a marker of improved LV function and a better clinical prognosis.
Transition from temporary microaxial left ventricular assist devices to durable mechanical circulatory support systems
Authors: Lewin D , Szymanski M K , Meyer A L , Saeed D , Scandroglio A M , Akhyari P , Meyns B , Loforte A , Oezkur M , Zimpfer D , Gustafsson F , Billion M , Belohlavek J , Bernhardt A M , Potapov E 
Published: November 2023

Abstract

Background
Circulatory support with a catheter-based microaxial temporary left ventricular assist device (tLVAD) plays a major role in the treatment of severe cardiogenic shock. In most patients who fail to recover while on temporary mechanical circulatory support (tMCS), durable left ventricular assist device (dLVAD) therapy is usually considered a reliable option. The aim of this study was to identify outcome predictors after the transition from a catheter-based microaxial tLVAD to dLVAD.

Methods
This is a retrospective analysis of data from a multicentre registry on patients who were transitioned from a catheter-based microaxial tLVAD to a dLVAD between 01/2017 and 10/2022 (n=341) from 19 European high-volume centres with regard to survival and outcome up to one year after dLVAD implantation.

Results
Patients were supported with an Impella 5.5 (92), 5.0 (155), CP (92), or 2.5 (2) and transitioned to Heartmate 3 (205), a HeartWare HVAD (129) or EXCOR VAD (7) during the same period. The Impella was implanted via the axillary artery in 245 (71.8%), the femoral artery in 93 (27.3%), and via direct access to the aorta in three (0.9%) patients. One hundred and thirty-three (40.5%) patients additionally required extracorporeal life support before and/or during Impella therapy. The aetiology of cardiogenic shock necessitating tMCS was most commonly acute myocardial infarction (31.7%), followed by acute decompensation of ischaemic (28.4%) or dilated cardiomyopathy (27.0%). The 30-day and 1-year survival were 87% and 70%, respectively. The uni- and multivariable analysis included 312 patients with an at least 1-year follow-up or death within the first year after dLVAD implantation. The following risk factors for 1-year mortality were identified: age (OR 1.02), specifically age over 55 years (OR 1.09), BMI &gt;30 kg/m² (OR 2.2), female sex (OR for male sex 0.4), as well as elevated total bilirubin (OR 1.13) and low platelet counts (OR 0.996).

Conclusions
During preoperative conditioning, efforts should be undertaken towards normalising platelet counts and liver function. Using the identified risk factors as a basis, we created a risk score to estimate 1-year mortality to optimise patient selection for dLVAD implantation, with the aim of improving the outcome in this critical patient population.Normogram 1y-mortality prediction scoreCIF death grouped by quartiles of score
Necropsy findings in heart transplant recipients with and without primary graft dysfunction: a retrospective study
Authors: Belfort D S P , Mangini S , Avila M S , Marcondes-Braga F G , Campos I W , Seguro L F B C , Bacal F , Gutierrez P S 
Published: November 2023

Abstract

Background
Primary graft dysfunction (PGD) is the leading cause of death in the first year after heart transplant (HT). Physiopathology of PGD is not clear, and histological findings are not defined in literature.

Purpose
The objective of this study is to describe the morphological findings in the hearts of patients who died within the first 14 days after HT and to compare findings between 2 groups: a group with the diagnosis of PGD and a group without PGD.

Methods
We included all adult patients submitted to HT in one center who died within the first 14 days after the procedure and were submitted to necropsy between January 1st, 2013 and March 31st, 2020. Demographic, perioperative, histological and immunohistochemical data on heart slides obtained on necropsy were recorded retrospectively. We retrospectively analyzed if the patients met the ISHLT criteria for PGD, and then we categorized them in two groups: PGD group or non-PGD group. All heart slides were reviewed by an experienced pathologist considering the presence of histological features of acute cellular rejection, antibody-mediated rejection, necrosis and its morphological characteristics if present. Pathologist was blind for each patient group. We considered the necrosis significant if it took more than 10% of the examined area. All findings were compared between groups.

Results
Among 322 HTs performed, 31 patients died within 14 days after the procedure. Five patients were not subjected to autopsy, and the remaining 26 patients were included. Twelve patients presented PGD, while 14 patients did not. Comparison between groups shows longer ischemia time, higher incidence of pre-transplant mechanical circulatory support, lower post-transplant left ventricular ejection fraction and higher incidence of post-transplant right ventricular dysfunction in PGD group (Table 1). Necropsy findings were similar between groups and four patterns of necrosis were found, namely microcalcified, contraction-band, coagulative and liquefactive necrosis (Table 2). Necrosis was detected in the 80.7% of all cases, taking more than 10% of the myocardial area in 46.1% of them. Seven patients (26.9%) presented signs of mild cellular rejection (1R). One of them had also antibody-mediated rejection. One patient presented hyperacute graft rejection. The cause of death was defined by necropsy in 21 cases. The most common cause of death in PDG group was cardiogenic shock (66.7%), while in non-PGD group septic shock (28.5%) and bleeding (21.4%) were the most common causes.

Conclusion
While left ventricular ejection fraction was significantly lower in PGD group, necrosis was a frequent finding both groups, raising the hypothesis maybe necrosis is not directly the cause of cardiac dysfunction in PGD. More studies are needed to fully understand PGD pathology.Table 1Table 2
Elevated lipoprotein a level in heart transplant patients is associated with cardiac allograft vasculopathy
Authors: Enriquez Vazquez D , Barge-Caballero E , Domenech-Garcia N , Rodriguez-Vazquez P , Formoso-Lavandeira M D , Barge-Caballero G , Couto-Mallon D , Paniagua-Martin M J , Blanco-Canosa P , Grille-Cancela Z , Lopez-Canoa J N , Lopez-Vazquez P , Vazquez-Rodriguez J M , Crespo-Leiro M G 
Published: November 2023

Abstract

Introduction
Lipoprotein A (LpA) is considered a cardiovascular disease (CVD) risk factor and its interest has grown in recent years. High LpA levels (above 50 mg/dL) are associated with an increase in the occurrence of CVD and degenerative aortic valve disease despite treatment with statins and low LDL levels. The prevalence of elevated LpA levels after heart transplantation (HT) and the implication on the development of cardiac allograft vasculopathy (CAV) is not well known.

Objective
To assess the prevalence of elevated LpA levels in patients with HT and the relationship between higher LpA levels and CAV at 1 year.

Methods
Retrospective, unicentric and observational study based on the historical cohort of HT patients. We selected those patients in whom a pre-transplant serum sample was available in the biobank for LpA analysis. CAV was diagnosed with coronary angiography.

Results
We studied 80 HT patients. Baseline characteristics are in table 1. Median LpA levels were 14.5 (5.0-35.3), and from the 80 HT patients, 16 (20,0%) had LpA≥50 mg/dl (figure 1A). Out of the 80 patients, 68 had a coronary angiography at 1 year follow up (3 died before 1 year and 9 patients did not have angiography at 1 year for diverse reasons).
Twenty patients (29.4%) presented CAV in the first year. Patients with elevated LpA levels had more frequency of CAV at 1 year [11/16 (68.8%) vs 9/43 (17.3%); p&lt;0,001]. LpA levels in patients with CAV was higher (62.5+-58.8 vs 23.9+29.8; p&lt;0,001) (figure 1B).
LDLc and Total cholesterol were significantly lower in patients with CAV at 1 year in this population. In univariate analysis, smoker donors were associated with CAV development (60.0% vs 33.3%; p 0.042). We did not find differences in other recipient or donor cardiovascular risk factors, rejection episodes or CMV infection in the first year.

Conclusion
Elevated LpA levels (≥50 mg/dl) are frequent in HT patients (20%) and in our cohort, were associated with CAV at 1-year post-HT. Further studies are needed to verify these results and study the relationship with the development of other cardiovascular events in HT patients.Table 1Figure 1
The "Triage" clinic: close communication between hospital and community heart failure unit reduces readmissions
Authors: Weinstein J M , Kiselnik D S , Sidi A , Hemo Z , Guterman E , Refaelovich E 
Published: November 2023

Abstract

Background
Heart Failure (HF) causes an immense medical and financial burden on health systems. Recurrent hospitalizations lead to a severe reduction in quality of life and worsen prognosis. The chance of readmission is 24% within a month after discharge and over 50% within 6 months, despite great improvements in treatment. A large proportion of readmissions are for noncardiac reasons.

Aim
To reduce readmissions in patients recently discharged from a hospitalization for HF worsening, by improving and promoting close communication between hospital and community.

Methods
We initiated a pilot study at our community HF unit (HFU), whereby details of patients hospitalized for HF on two general medical wards were sent directly by the ward nursing staff to the HFU head nurse, and the patients were invited to the HFU as soon as possible after discharge (the Triage clinic). The treatment protocol included IV therapy where indicated (furosemide, iron) and titration of oral medications, with close medical and laboratory follow-up. Readmissions rates over 1, 3, 6 & 12 months (for HF or all causes, including HF) were compared to the equivalent period prior to the index admission. A further comparison was made with a control group of HF patients invited to the HFU but who chose not to attend.

Results
Between 2/2020 and 3/2021, 108 patients were seen in the Triage clinic, within an average time of 11 days from discharge. After the first visit, 10 patients were discharged and 1 died. 97, 75 & 46 patients completed follow-up of 3, 6 & 12 months, respectively. Readmissions for HF were 50% lower over 1,3, & 6 months compared to the equivalent period before treatment in the Triage clinic, and 15% lower after 12 months. Readmissions for all causes were 45% lower over 1, 3 & 6 months compared to the equivalent period before treatment in the Triage clinic, and 35% lower after 12 months. In the control group, 55, 33 and 15 patients completed follow-up of 3, 6 & 12 months, respectively. On comparing the Triage group to the control group, there was a reduction of 75% in recurrent admissions for HF or all causes after 1 month, and 60% reduction after 3, 6 and 12 months. In the Triage group, there were an average 2.5 changes in therapy per patient per month. On average, there was an average 1.6 IV furosemide and 2.6 IV iron treatments per patient per year. The functional capacity improved by a factor of 2.5.

Conclusions
Promoting close communication between hospital and community can lead to a significant improvement in HF care, as seen by better quality and efficacy of therapy and speed of access. This in turn reduces rehospitalizations and improves quality of life.
The effect of SGLT2 inhibitor on clinical outcomes in patients with type 2 diabetes and atrial fibrillation
Authors: Shin S H , Cho Y , Park M A , Jang J H , Kim D Y , Kim S H 
Published: November 2023

Abstract

Background
Atrial fibrillation (AF) is the most common arrhythmia and represents a significant public health burden with an increased risk of stroke, heart failure (HF) and mortality. Sodium glucose cotransporter 2 (SGLT2) inhibitors improve clinical outcomes in several populations including type 2 diabetes, chronic renal insufficiency, and HF. However, limited data exist on their effects on AF.

Purpose
We investigated impact of SGLT2 inhibitor on clinical outcomes compared to dipeptidyl peptidase 4 (DPP4) inhibitor among patients with type 2 diabetes and AF.

Methods
We conducted a retrospective cohort study using the National Health Insurance Service database. A total of 4,771 patients with type 2 diabetes and AF who were newly prescribed SGLT2 inhibitors or DPP4 inhibitors from Jan 2014 to Dec 2019 were selected and matched in a 1:2 ratio by propensity score with 38 confounding variables. We assessed the relationship of SGLT2 inhibitor with clinical outcomes including mortality, stroke, myocardial infarction (MI) and hospitalization for HF compared with DPP4 inhibitor using Cox regression model.

Results
Over the follow-up, 181 patients (3.7%) died, 121 patients (2.5%) were hospitalized for HF, 95 patients (2.0%) experienced MI, and 293 patients (6.1%) had stroke. Compared to DPP4 inhibitor, SGLT2 inhibitor was associated with lower risk of mortality (HR 0.61; 95% CI 0.39-0.94; P=0.025), but not of MI (HR 1.22 [95% CI 0.71-2.08]; P=0.46) or stroke (HR 1.0 [95% CI 0.75-1.33]; P=0.98). While the incidence of hospitalizations for HF tended to be lower in the SGLT2 inhibitor group, it did not reach a statistical significant level (HR 0.63 [95% CI 0.39-1.02]; P=0.06).

Conclusion
In a nationwide cohort of patients with type 2 diabetes and AF, SGLT2 inhibitor was associated with a lower risk of mortality compared to DPP4 inhibitor.
Soluble transferrin receptor as a marker of tissue iron deficiency: impact on health-related quality of life in patients with heart failure without systemic iron deficiency or anaemia
Authors: Ras Jimenez M , Ramos Polo R , Jimenez Marrero S , Jose Bazan N , Corbella M , Calero Molina E , Alcoberro L , Quiros Hidalgo E , Enjuanes Grau C , Yun Viladomat S , Ruiz Munoz M , Garay A , Moliner P , Comin Colet J 
Published: November 2023

Abstract

Background
Soluble receptor of transferrin (sTfR) is a marker of tissue iron status and may help to inform on subtle iron depletion and increased iron demand of functional proteins at tissular level even in the absence of systemic iron deficiency or anaemia. Raised sTfR levels have been associated with of all-cause mortality and impaired exercise capacity in patients with heart failure (HF). However, the impact quality of life (QoL) has not been evaluated.

Purpose
The aim of our study was to describe the association between sTfR as a marker of increased iron demand and tissue iron deficiency and QoL in non-anaemic patients with HF and normal systemic iron status.

Methods
We conducted an observational, prospective, cohort study of 1120 consecutive patients with chronic HF (DAMOCLES study). For the current sub-study, we selected all patients form the DAMOCLES cohort that had normal haemoglobin levels and normal systemic iron and available QoL data. Tissue ID was defined as levels of sTfR&gt; 75th percentile (1.63mg/L). To assess QoL, we used the Minnesota Living with Heart Failure Questionnaire (MLHFQ). The primary endpoint was the overall summary score (OSS) of the MLHFQ instrument self-administered at inclusion in the study.
The unadjusted parametric and non-parametric associations between sTfR and the MLHFQ OSS scores were explored using General Additive Models (GAM). Univariate and multivariate linear regression models were constructed to explore the associations between sTfR levels and tissue ID and the QoL scores. All models were adjusted by age, sex, and prognostic factors such as LVEF, NYHA, NT-proBNP levels and iron status parameters among other well-known determinants of HF severity.

Results
The final study cohort consisted in 206 patients. Mean age was 70±12 years, mean LVEF was 43±15% and 61 (30%) were women. Mean sTfR values were 1.42±0.66 mg/L. Tissue ID was present in 54 patients (26%). Mean MLHFQ OSS were 42±26. Global QoL was significantly worse in patients with tissue ID compared to patients without tissue ID (51±27 vs. 39±20, p-value=0.006, respectively). In unadjusted GAM models (Figure 1) showed a direct and significant association between increased iron demand and worse global QoL with a linear p-value&lt;0.0001.
As shown in Table 1, higher sTfR were associated with higher MLHFQ OSS scores in unadjusted models. These findings were confirmed in forward stepwise multivariate linear regression models (Table 1).

Conclusions
In a cohort of HF patients without iron deficiency or anaemia, higher levels of sTfR indicating increased iron demand and tissue ID were associated with worse QoL.
Hemodynamic forces analysis using transthoracic echocardiogram in acute heart failure
Authors: Vassia V , Pantaleoni S , Ferrando F , Airale L , Milan A , Norbiato C , Iannaccone A 
Published: November 2023

Abstract

Introduction
Heart failure (HF) represents a major health problem, being one of the leading causes of hospitalization.
At present, echocardiography plays a key role in HF diagnosis and many innovations have been made. Particularly, in the last decades attention was directed towards fluid dynamic study, as it seems to better predict ventricular dysfunction. Therefore, the concept of hemodynamic forces (HDF) was introduced.

Purpose
The aim of our study was to evaluate HDF in patients with acute HF in the setting of the Emergency Room and at the time of recovery, furthermore, comparing them with healthy volunteers. Patients were also contacted 30 days after discharge in order to evaluate whether there had been new hospital admissions.

Methods
We enrolled 132 patients, of whom only 14 were effectively recruited given the need for the presence of sinus rhythm and the absence of severe valvulopathies. These patients were compared with 8 healthy volunteers. All individuals underwent trans-thoracic echocardiography, in order to assess cardiac morphology and function. HDF analysis was performed using QStrain software.

Results
The graphical presentation of HDF analysis differed in a statistically significant manner between patients with acute HF and healthy volunteers, with the first group showing a lower systolic peak (7.66% [6.32;14.3] vs 21.6 % [18.4;26.7]; p 0.003) and a shorter diastolic time (372 msec [342;472] vs 631 msec [468;679]; p = 0.012). Moreover, in patients with HF we identified a statistically significant reduction of the Inward Displacement (ID), a recently introduced parameter of systolic function, (12667 [10404;22647] vs 27289 [25131;29001]; p 0.003) and an increased systolic ratio, consisting of the ratio between transverse and apical-basal HDF (23.6±10.9 in HF patients vs 17.5±5.60 in healthy subjects; p = 0.102).
Comparing patients with HF in the acute phase and at the time of recovery, we couldn’t obtain statistically significant results due to the small sample size. However, considering case by case, we pointed out a difference in ID and in systolic ratio which seemed to better identify effective hemodynamic stability compared with Ejection Fraction (EF) and Global Longitudinal Strain (GLS).

Conclusion
Our study appears to be the first one to evaluate HDF in the setting of acute HF. Our results suggest how HDF analysis could be a useful tool improving HF management, particularly leading to a better identification of effective hemodynamic compensation.
However, we also emphasized the limitations of this tool, which currently restrict its use to the outpatient setting, particularly in the field of research.