bluuebunny/crossref_metadata_2025_split huggingface dataset:
Strategic noninvasive multimodal assessment of cardiac performance in patients with heart failure
Authors: Cho J S , Kim M J , Lee K S , Lee M H , Kim D W , Kim T S , Park M W 
Published: November 2023

Abstract

Aims
We sought to evaluate whether a noninvasive combination assay targeting left ventricular filling pressure (LVFP) would be useful for risk stratification of patients with heart failure (HF). Although abnormal LVFP is inevitably related to HF outcomes, its noninvasive application remains difficult in daily practice.

Methods
This prospective observational study enrolled consecutive hospitalized HF patients. According to the baseline N-terminal pro-B-type natriuretic peptide (NT-proBNP) and Doppler echocardiographic diastolic assessments, patients were classified into three groups: normal range of both LVFP and NT-proBNP (Group 1), normal range of LVFP but elevated NT-proBNP (Group 2), and elevated LVFP and NT-proBNP (Group 3). The primary endpoints were the composite adverse cardiovascular events.

Results
Event-free survival in Group 2 (n = 56, mean age of 65.4±12.4) was better than that in Group 3 (n = 45, mean age of 68.5±11.5) but worse than that in Group 1 (n = 123, mean age of 61.4±10.5) (log-rank p &lt;0.001). Cardiopulmonary exercise test (CPET) findings were compatible with these findings. Left atrial strain showed better risk stratification than left atrial volume index. Serial addition of left atrial assessment and CPET in the model incrementally enhanced the predictive power of LVFP-based stratification for adverse events.

Conclusions
The strategic combination of NT-proBNP, echocardiographic LVFP and left atrial function, and CPET is helpful to predict adverse clinical outcomes in patients with HF. The larger the number of combined cardiac performance indicators, the better the noninvasive risk-stratification was.
Prognostic significance of growth differentiation factor-15 across the BMI spectrum in patients with chronic heart failure: Insights from the SUPPORT trial
Authors: Teramoto K , Nochioka K , Sakata Y , Nishimura K , Shimokawa H , Yasuda S 
Published: November 2023

Abstract

Background
Obesity is a risk factor for cardiovascular diseases including heart failure (HF), yet patients with obesity have better outcomes than their leaner counterparts in HF (i.e. the obesity paradox). We sought to investigate whether growth differentiation factor-15 (GDF15), an emerging biomarker in HF reflecting inflammation and oxidative stress, is a prognostic indicator across the body mass index (BMI) spectrum in chronic heart failure (CHF).

Methods
Serum levels of GDF15 and its prognostic significance across BMI were examined in a total of 1,040 Japanese patients with CHF enrolled in a randomized clinical trial of the SUPPORT trial (supplemental benefit of an angiotensin receptor blocker in hypertensive patients with stable heart failure using olmesartan) (mean age 66.0±9.9 years, 26% female). Patients were categorized into four groups: underweight (BMI &lt;18.5 kg/m2; n = 56), normal (BMI 18.5-22.9; n = 304), overweight (BMI 23-24.9; n = 257), and obese (BMI ≥25; n = 423) defined based on the WHO recommendation for Asian-Pacific population.

Results
The underweight group consisted of older patients with a higher prevalence of NYHA class III and reduced left ventricular ejection fraction (LVEF) compared to obese patients (mean age 69.0 vs 64.7 years, NYHA class III 17.9 vs 5.9%, and mean LVEF 49.3 vs 55.5%; all p&lt;0.05). Median GDF15 level in the underweight group was higher (1,864 pg/mL [IQR 1,070-2,626]) but was similar in overweight and obese groups (1,285 [953, 1772] and 1,220 [888-1,789], respectively) compared to normal BMI group (1,276 [879-2,018]). During follow-up (median 10.3 years), 540 composite events of HF hospitalization or all-cause death occurred. The risk was higher in the underweight group (adjusted HR 1.8, 95%CI [1.3-2.5]) and lower in the obesity group (adjusted HR 0.8 [95% CI 0.6-0.9]) compared to the normal BMI group. An increased GDF15 incurred a consistently higher risk from underweight to obese groups; per unit increase in logGDF15 (pg/mL) was associated with 4.1, 2.4, 1.7 and 2.4 times higher risk, respectively. The optimal cut-off point for discriminating those with and without the composite events was 1,343 pg/mL in overall patients. This cut-off value performed well as a prognostic indicator across the continuous BMI spectrum including those with higher BMI (Figure).

Conclusions
The prognostic significance of GDF15 persisted across the BMI spectrum in patients with CHF. GDF15 may be useful for providing prognostic information across patients with a diverse range of BMI even in those with modest outcomes.HF events in high GDF15 across BMI
Visit-to-visit glycemic variability is associated with the incidence of heart failure with improved ejection fraction
Authors: Yang C D , Wang X Q 
Published: November 2023

Abstract

Background
With advanced guideline-directed therapies, a substantial portion of heart failure (HF) patients have experienced improvement of ejection fraction (EF), termed HFimpEF.

Purpose
In the present study, we sought to investigate the association between visit-to-visit glycemic variability (GV) and the incidence of HFimpEF.

Methods
From January 2013 to December 2020, 951 hospitalized HF patients with reduced EF (HFrEF, EF≤ 40%) were consecutively enrolled and followed up for around 12 months. The incidence of HFimpEF, defined as (1) an absolute EF improvement ≥10% and (2) a second EF &gt; 40% and its relationship with visit-to-visit fasting plasma glucose (FPG) variability were analyzed.

Results
A total of 519 HFrEF patients were finally enrolled. During a mean follow-up of 12.2 ± 0.6 months, 218 (42.0%) patients developed HFimpEF. Multivariate analysis showed visit-to-visit FPG variability was independently associated with incidence of HFimpEF after adjustment for baseline HBA1c, mean FPG during follow-up and other traditional risk factors (odds ratio [OR] for highest vs. lowest quartile of CV of FPG: 0.487 [95% CI 0.257∼0.910]). Assessing FPG variability by alternative measures yielded similar results. Subgroup analysis revealed the relationship between GV and HFimpEF was only observed in HF of ischemic etiology and the association persisted significant irrespective of glycemic levels and diabetic conditions.

Conclusions
This study reveals that greater visit-to-visit FPG variability is associated with compromised development of HFimpEF independent of mean glycemic levels and diabetic conditions. Therapies targeted at improving GV might provide favorable effects on myocardial recovery in HF patients even without diabetes.Fig 1Fig 2
Continuous measurement of percutaneous oxygen saturation during 6-minute walk test is useful for stratification of the prognostic risk in patients with heart failure
Authors: Sunayama I , Min K D , Orihara Y , Ono J , Matsumoto Y , Soyama Y , Manabe E , Oboshi M , Azuma K , Sugahara M , Eguchi A , Nishimura K , Naito Y , Asakura M , Ishihara M 
Published: November 2023

Abstract

Background
The 6-minute walk test (6MWT) is an established test to assess the functional exercise performance and the 6-minute walk distance is strongly correlated with the functional capacity and the prognosis in patients with heart failure (HF). Also, the hypoxia during 6MWT is reported to be associated with severity of pulmonary diseases. However, no study has reported the clinical implication of sequential changes in percutaneous oxygen saturation (SpO2) during 6MWT was not investigated in HF patients.

Purpose
To prospectively clarify the association between sequential changes in SpO2 during 6MWT and prognosis in patients with HF.

Methods
In this prospective observational study, 50 patients admitted to our hospital with acute heart failure were enrolled. The 6MWT was performed at the time before discharge, after hemodynamic stability was confirmed. The average of SpO2 was calculated from data obtained at rest (3 minutes just before the test) and during 6MWT by employing the wearable pulse-oximeter which are designed to record and store the SpO2 value every seconds. Alternations in SpO2 (Δ SpO2) were analyzed by subtracting the average during 6MWT from that at rest. Patients were followed 1 year for composite outcome of heart failure-hospitalization and death).

Results
The mean age of participants was 78.8 years, and 23 (46%) were female. The mean EF was 46.1% and the number of the patients with EF≧50, 50&gt;EF&gt;40, 40≧EF were 22, 6, and 22, respectively. Mean NT-proBNP was 4374.5pg/ml. The mean walk distance was 250 ± 112m and the mean Δ SpO2 was 2.88 ± 4.3%. All cases were classified by walk distance and Δ SpO2; long- (&gt;220m) vs. short-distance group (≦220m) and low- (&lt;3.5%) vs. high-ΔSpO2 group (≧3.5%). There were no significant differences in cardiac parameters and respiratory function between long- and short-distance group as well as between low- and high-ΔSpO2 group. Kaplan-Meier analysis revealed that cardiac event rate was higher in the short-distance group than in the long-distance group (HR = 2.89, CI = 1.24-6.71, p = 0.014), and higher in the high-Δ SpO2 group than in the low-ΔSpO2 group (HR = 3.49, CI = 1.55-7.83, p = 0.002) (Figure 1A and 1B). When these classifications were combined, the patients with short-distance and low-ΔSpO2 showed remarkably high event rate of 91% (Figure 2).

Conclusions
This study showed that, compared to walk distance, ΔSpO2 was more predictive of prognosis of heart failure patients, and that the combination of ΔSpO2 and walk distance may identify the highest risk group. The elucidation of the usefulness of continuous SpO2monitoring during 6MWT as the marker for severity of heart failure and treatment effect warrants further investigation.Figure1Figure 2
MUC-16, tumour and congestive heart failure marker, is expressed on epicardial mesothelial cells and is inversely associated with epicardial fat genesis
Authors: Eiras S , Fu X , Nunez-Camano J R , De La Espriella R , Nunez J , Gonzalez-Juanatey J R 
Published: November 2023

Abstract

Background
CA-125 or mucin-16 (MUC-16) is a protector protein on epithelial luminal surfaces against physical stress through hydration process. However, some evidence suggests a role in fibrogenesis. MUC-16 can be detected in plasma after proteolytic cleavage with a predictive value for heart failure progression. Our main objective was to study the expression levels of this glycoprotein on epicardial mesothelial cells, its association with epicardial fat genesis, and biochemical markers.

Methods and results
We have used epicardial and subcutaneous fat from patients(n = 29) undergoing open heart surgery under informed consent and after approval by Ethics Committee. MUC-16 expression levels were detected on formalin-fixed paraffin-embedded epicardial fat biopsies with CA-125 antibody or real-time PCR on stored biopsies (n = 18) at -80ºC. Epicardial cells scraped with a scalpel were cultured and their MUC-16 expression was confirmed with a specific antibody and secondary fluorescent antibody. Primary cultures from epicardial stromal cells of 8 patients were obtained with collagenase digestion. After 15 days, adipogenesis was induced for 15 days with an adipogenic cocktail. Adipogenesis (AdipoQ) and mesothelial (ITLN-1) markers were quantified by real-time PCR on cells with and without adipogenesis. CA-125 expression levels were analyzed by real time-PCR on epicardial fat from 18 patients, as well as inflammation, fibrosis, stretch and adiposity markers levels on plasma by multiplex assay.
Our results showed that MUC-16 is localized on epicardial mesothelial cells but not on adipocytes. The MUC-16-stained cells can be cultured and isolated after scraping the epicardium. The isolated epicardial stromal cells with collagenase showed a positive relationship between mesothelial maker (ITLN-1) and CA125 (Figure below). The higher presence of MUC-16 levels was inversely associated with AdipoQ after adipogenesis induction. From 8 plasma studied proteins, thrombospondin-2 (TP-2), was the best associated protein with MUC-16 on epicardial fat (r = 0,472; p = 0,48).

Conclusion
Epicardial cells express MUC-16. These types of cells can be isolated and cultured for studying their cleavage regulation and modulation. Epicardial stromal cells with a higher percentage of MUC-16 reduce the epicardial fat genesis. Further studies are needed for finding the main circulating plasma levels associated with epicardial MUC-16.
Urinary biomarkers in different diuretic response groups with heart failure
Authors: Kozluca V , Akbulut Koyuncu I M , Baskovski E , Tan T S , Ozdol C , Tutar D E 
Published: November 2023

Abstract

Purpose
Predicting diuretic response in different hemodynamic profiles is challenging in heart failure patients. Worsening renal function with diuretic therapy leads to decision making more difficult. Spot urinary sodium is an important milestone to determine decongestion therapy intensity. Serum biomarkers are widely used for diagnosis and follow up but more urinary biomarkers can be identified for risk stratification.

Methods
We enrolled 61 patients with decompansated heart failure on the first day of admission. Baseline characteristics and urinary biomarkers were recorded. Diuretic response was classified as good or poor response groups according to spot urine sodium within second hour after first intravenous diuretic administration. Quantitative variables were specified as mean ± standard deviation, categorical variables were specified as frequency and percentage. Mean differences were assessed with Student-T test and Welch test. Statistically significant parameters were also assessed with logistic regression analysis.

Results
Only U/P creatinine ratio and urine creatinine were statistically lower in good diuretic response group (p&lt;0.0001). Fractional excretion of urea and potassium were higher in good response group (p&lt;0.0001 and p&lt;0.005). Urinary sodium to potassium ratio, UNa/UCr and UK/UCr are also statistically higher in the good response group (p&lt;0.0001). Sodium associated parameters (UNa/UK, UNa/UCr) and urinary creatinine were also significant in logistic regression.

Discussion
Urinary biomarkers are not well defined parameters in heart failure patients but these parameters may be more dynamic than serum parameters as spot urine sodium. Our data indicates that poor response group has a more prerenal phenotype than good response group.Table 1.Urine biomarker definitionsTable 2.Results
NTproBNP values for the diagnosis of congestive heart failure in dyspneic old patients regarding age
Authors: Berthelot E , Bounab R , Bailly M T , El Blidi M , Lehova X , Jourdain P 
Published: November 2023

Abstract

Background
The diagnosis of heart failure (HF) in elderly patients is often difficult, due to overlap of typical signs and symptoms with those of comorbidities. Plasma N-Terminal Pro-Brain Natriuretic Peptide(NTproBNP) is known to increase with age and according to comorbidities. However, the diagnostic performance of this biomarker is unclear in those patients.

Aims
This study sought to define the diagnostic accuracy of plasma NTproBNP in patients over 75 yo in a large population referred for acute dyspnea in the Assistance Publique-Hôpitaux de Paris.

Methods and Results
In this retrospective, longitudinal multicenter cohort study, we collected data from 12,974 patients aged 75 years or older who were hospitalized for acute dyspnea with NTproBNP measurement in the 48 hours after admission between 2011 and 2021 in geriatrics, cardiology and pulmonology departments. The final diagnosis was classified with the International Classification of Diseases, 10th Revision (ICD 10) as either "AHF" or "other acute respiratory failure" (OARF), represented by pulmonary embolism, COPD and pneumonia. The Mean (SD) age of our population was 84.4 (6.1) years old, and 52.7% of patients were women. 8,385 (64.6%) patients had an AHF diagnosis at discharge. Regarding age of patients, NT-proBNP threshold values was higher in patients over 85 yo, 2530 ng/L, compared to that of patients &lt; 85 yo, 1680 ng/L. The NTproBNP threshold for ‘ruling-out’ AHF had a 79% sensitivity in patient &gt; 85 YO and 82% sensitivity in patient 75- 85 YO. In patients &gt; 85 compared with patient 75-85 yo, predictive positive value was 85 and 86 %, specificity was 65% and 75% and AUC was 0.77 and 0.84. Finally, despite the consideration of other clinical and biological parameters, NTproBNP level remain more discriminating for the diagnosis of AHF in old patients with comorbidities.

Conclusion
In patients 75-85 and over 85 years of age referred for acute dyspnea with NTproBNP dosage at admission, a cutoff of 1680 and 2530 ng/L respectively allow for an accurate diagnosis of AHF.
Lack of correlation between levels of surfactant B and NT-pro-NBP in acute heart failure: an admission to discharge study
Authors: Novello G , Bursi F , Bonazzi C , Furlotti N , Rusconi I , Mondellini G , Vivona P , Galluccio E , Martin D , Caretti A , Guazzi M 
Published: November 2023

Abstract

Background
Acute pulmonary edema (APE) is a main cause of hospitalization for heart failure (HF). Surfactant type B (Surf-B) is a sensitive biomarker of alveolar damage that has been partially studied in chronic HF unless acute HF.

Aims
To clarify the pattern of Surf-B changes compared to the gold standard NT-pro-BNP after decongestion therapy.

Methods
36 patients with acute HF due to APE (average age 74,9 ± 8,94; LVEF 36,7 ± 12,6; 61,0% males) underwent a combined evaluation of Surf-B, NT-pro-BNP levels with quantification of B-lines at hospital admission (time 0) and discharge (time 1).

Results
At time 1, the average Surf-B and NT-pro-BNP and B- lines were significantly lower compared to time 0. Interestingly, no correlation between Surf B and NT-pro-BNP was observed either at time 0 and time 1. A correlation between B-lines and Surf-B was observed only at time 0 while the correlation between NT-pro-BNP and B lines was observed just at time 1 (Table). Despite the significant average changes in Surf-B from admission to discharge, 28% of cases behaved as non-responders exhibiting a lack of reduction in Surf-B compared to NT-pro-BNP at time 1.

Conclusions
These data suggest that an organ specific biomarker of lung organ damage such as Surf-B is sensitive to decongestion therapy at a different extent compared to NT-pro-BNP with the two biomarkers that do not correlate each other. The evidence of a 28% cases of Surf-B non-responder subjects suggests that reparative process of alveolar break damage may dissociate from hemodynamic and cardiac benefits in acute HF.Table
Longitudinal association of subclinical cardiac function with cognitive function
Authors: Huynh Q , Marwick T H 
Published: November 2023

Abstract

Background
Cognitive impairment and heart disease frequently co-exist due to shared disease processes and pathological mechanisms. The presence of one may lead to and/or worsen the other. This bidirectional relationship between cognitive impairment and heart disease acts as a vicious cycle that increases the burden of both diseases. Our previous findings have demonstrated that cognitive impairment is a strong predictor of post-discharge readmission or death in heart failure, second only to heart failure severity. However, whether heart failure and cognitive impairment has a causal relationship remains unknown. This study sought to determine the relationship between subclinical cardiac function and cognitive function.

Methods
This study included 1977 consecutive patients (62% men, aged 73±13 years) with heart failure ranging from stage A to C. These patients were followed up for 36 months. At both baseline and follow-up, subclinical cardiac function was measured by echocardiography, and cognitive function was measured using Montreal Cognitive Assessment (MOCA). Other measurements included blood biochemistry, comorbidities, physical measurements and questionnaires.

Results
Cognitive function was strongly associated with both readmission and death in patients with heart failure, particularly among those with stage C. Among patients with heart failure stage A or B, left atrial volume index (LAVI) and E/e’ were associated with a reduction of MOCA score and higher risks of newly developed cognitive impairment at 36-month follow-up (OR = 1.04 [95% CI:1.02-1.07] per 1ml/m2 LAVI, and OR = 1.07 [95% CI:1.01-1.15] per 1 unit E/e’). Patients with cognitive impairment have significantly enlarged left atrium, compared with those with normal cognition (p&lt;0.001). While almost all (93%) of patients with consistent cognitive impairment from baseline to follow-up had an enlarged left atrium, 71% of those who became cognitively impaired at follow-up had an enlarged left atrium.

Conclusions
The longitudinal relationship between diastolic cardiac function and cognitive function suggests a causal pathway between these two. Assessment of cognitive function is recommended in patients with impaired cardiac function.
Association between cardiac time intervals and incident heart failure after acute coronary syndrome
Authors: Bjerregaard C , Skaarup K G , Olsen F J , Iversen A , Joergensen P G , Pareek M , Galatius S , Pedersen S , Biering-Soerensen T 
Published: November 2023

Abstract

Background
Cardiac time intervals are sensitive markers of myocardial dysfunction that predisposes to heart failure (HF). Color tissue Doppler imaging (TDI) curved M-mode is a reliable method for measuring cardiac time intervals.

Purpose
We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS).

Methods
This was a retrospective cohort study of 580 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination performed a median of two days after PCI. By echocardiography cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) were obtained by TDI curved M-mode and used to derive the myocardial performance index (MPI). The outcome was incident HF. Patients with prevalent at baseline HF were excluded from the analysis.

Results
The final study sample consisted of 387 patients, 73% were male, the mean age was 64 years, 76% of the ACS events were STEMI and LVEF and GLS were 42% and -13.1%, respectively. During follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, longer combined indexes were associated with a higher risk of HF (IVRT/ET: HR 1.24 (1.07-1.43), P = 0.003, per 0.1 increase) and (IVCT/ET: HR 1.44 (1.10-1.91), P = 0.010, per 0.1 increase), and so was higher MPI (HR 1.20 (1.08-1.34),P = 0.001, per 0.1 increase). In addition, shorter ET was also associated with higher HF risk (HR 1.13 (1.07-1.18), P&lt;0.001 per 10ms decrease). MPI and IVCT/ET showed a curvilinear association with the outcome, whereas a linear association was observed for ET and IVRT/ET to the outcome (figure 1). After multivariable adjustment for cardiovascular risk factors, only MPI (HR 1.13 (1.01-1.27), P = 0.034), ET (HR 1.09 (1.01-1.17), P = 0.025), and IVCT/ET (HR1.37 (1.04-1.81), P = 0.023) remained significantly associated with HF.
Of note, left ventricular ejection fraction (LVEF) significantly modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF even in those with preserved LVEF (&gt;40%) (HR 1.13 (1.02-1.24, P = 0.017, per 10ms decrease), but not in those with reduced LVEF (HR 1.02 (0.96-1.08), P = 0.56, per 10ms decrease). These findings also persisted after adjustment for cardiovascular risk factors.

Conclusion
Shortened ET, prolongation of combined indexes, and higher MPI were associated with an increased risk of incident HF. In addition, shortening of the ET was associated with an increased risk of HF in patients with preserved systolic function by LVEF.