bluuebunny/crossref_metadata_2025_split huggingface dataset:
Right ventricular uncoupling in heart failure with preserved ejection fraction: a simple parameter to predict long-term mortality?
Authors: Burgos L , Campos Cevera L , De Bortoli A , Ballari F , Spaccavento A , Baro Vila R , Ricciardi B , Fasan M , Suarez L , Chicote F , Diez M 
Published: November 2023

Abstract

Introduction
Several prognostic models have been developed for risk stratification of mortality in patients with acute heart failure (AHF). eRecent evidence suggests that the right ventricular (RV)-pulmonary artery (PA) uncoupling is associated with poor outcomes in heart failure. Patients with heart failure and preserved ejection fraction (HFpEF) are a heterogeneous population with a wide range of clinical outcomes. However, the prognostic utility of RV-PA uncoupling for predicting long-term mortality in these patients remains elusive.

Objective
To assess the prognostic value of right ventricle-pulmonary artery coupling for long-term mortality in hospitalized patients with HFpEF.

Methods
Retrospective analysis of a consecutive, prospective, single-center cohort. Adult patients hospitalized between 2015 and 2020 with a primary diagnosis of AHF and left ventricular ejection fraction (LVEF) &gt;40% were included. The primary endpoint was long-term all-cause mortality. Ventricular uncoupling was assessed as the ratio of tricuspid annular plane systolic excursion (TAPSE)/pulmonary artery systolic pressure (PASP) estimated from an echocardiogram performed within 3 months of the index hospitalization. Univariable Cox proportional hazards regression models were used to calculate hazard ratios (HR), and multivariable Cox regression was performed with previously analyzed covariates: age, sex, atrial fibrillation, renal dysfunction and E/e'.

Results
Of 465 patients with HFpEF, 361 (77%) PASP and TAPSE could be estimated simultaneously. During a mean follow-up of 20.9 months, the primary outcome event occurred in 100 patients (27.7%). The optimal cut-off for the primary endpoint was TAPSE/PASP=0.38. Univariable Cox regression showed that RV-PA uncoupling was associated with the primary endpoint of long-term mortality (hazard ratio [HR] 1.96 [95% CI, 1.32-2.92], P=0.001). Kaplan-Meier analysis showed that patients with a ratio &lt;0.38 were at high risk of all-cause mortality (Figure 1). Multivariable analysis also showed that RV-PA uncoupling was significantly associated with long term mortality independent of age, sex, atrial fibrillation, renal dysfunction and E/e' (HR 2.21 [95% CI, 1.26-3.81], P=0.005).

Conclusions
In patients hospitalized for AHF with preserved ejection fraction, RV-PA uncoupling as determined by the TAPSE/PASP ratio was independently associated with long-term all-cause mortality. TAPSE/PASP was associated with mortality independently of age, sex, renal function, atrial fibrillation and diastolic dysfunction. This simple echocardiographic parameter may identify a population at higher risk for events during follow-up.Kaplan-Meier for all-cause mortality
In-hospital Prognostic Value of TAPSE/sPAP in Patients Hospitalized for Acute Heart Failure
Authors: Fauvel C , Pezel T , Rossanaly Vasram R , Charbonnel C , Bouleti C , Logeart D , Roubille F , Meune C , Nhan P , Ohlmann P , Bonnefoy-Cudraz E , Albert F , Andrieu S , Dillinger J G , Henry P 
Published: November 2023

Abstract

Background
Tricuspid annular plane systolic excursion over systolic pulmonary artery pressure (TAPSE/sPAP) assessed by echocardiography appears to be a good noninvasive approach for right ventricular to pulmonary artery coupling assessment. Yet, the in-hospital prognostic value of TAPSE/sPAP in patients hospitalized for acute heart failure (AHF) has never been explored.

Purpose
To assess TAPSE/sPAP prognostic value among patients hospitalized for AHF.

Methods
All consecutive major patients hospitalized for AHF across 39 French cardiology department, with TAPSE/sPAP measured by echocardiography within the 24 first hours of hospitalization were included in this prospective study. The primary outcome was in-hospital major cardiac adverse events (MACEs) defined as all-cause death, resuscitated cardiac arrest or cardiogenic shock.

Results
Three hundred and thirty-three patients with both AHF and TAPSE/sPAP measurement were included (mean age 68±14 years, 70% of male, 40% HFpEF, 18% HFmrEF, 42% HFrEF). In-hospital MACEs occurred in 50 (15%) of the patients. Using receiver operating characteristics curves analysis, the best threshold for in-hospital MACEs was 0.40 mm/mmHg. Patients with TAPSE/sPAP &lt;0.40 mm/mmHg had more frequently atrial fibrillation (p=0.024), chronic kidney disease (p=0.001), higher NTproBNP level (p&lt;0.001), and worse left and right ventricular function (p&lt;0.01). TAPSE/sPAP &lt;0.40 mm/mmHg was independently associated with in-hospital MACEs, even after adjustment with comorbidities (OR=3.75, 95%CI[1.87-7.93], p&lt;0.001), clinical severity (OR=2.80, 95%CI[1.36-5.95], p=0.006), or using a propensity matched population analysis (OR=2.98, 95%CI[1.53-6.12], p=0.002, figure 1). Finally, TAPSE/sPAP showed incremental prognostic value for in-hospital MACEs over traditional risk factors, including left ventricular ejection fraction (figure 2).

Conclusion
Emphasizing the prognostic value of TAPSE/sPAP &lt;0.40 mm/mmHg for in-hospital MACEs, over traditional risk factors, these results suggest embedding this parameter into clinical decision-making and risk stratification in patients hospitalized for AHF.
Validation of a new CPET multivariable score to predict cardiovascular events in heart failure patients
Authors: Borges-Rosa J , Fernandes R , Ar G O M E S , Campos G O , Monteiro E , Almeida Fernandes D , Ferraz Costa G , Guimaraes J , Milner J , Oliveira-Santos M , Goncalves L 
Published: November 2023

Abstract

Introduction
Cardiopulmonary exercise testing (CPET) is recommended in patients with heart failure (HF) to optimize exercise prescription and as part of the evaluation for heart transplantation. Recently, a new multivariable score (MVS) was proposed as a powerful method to predict HF events with an optimal cut-off value of 120.

Purpose
We aimed to evaluate the prognostic value of this tool in patients with HF.

Methods
We conducted a single-centre study assessing consecutive patients with HF who underwent CPET from 2013 to 2017. Classic and recently proposed variables were collected, including peak O2 uptake (pVO2), minute ventilation–CO2 production (VE/VCO2 slope), partial pressure of end-tidal CO2 at the anaerobic threshold (PETCO2L), circulatory power (CP=pVO2 x peak SBP), and ventilatory power (VP=peak SBP/(VE/VCO2) slope). The score was calculated as follows: (pVO2 × 2.194) + (PETCO2L × 1.545) + (LVEF × 1.134) + (HR × 1.055; 0 if AF, 1 if sinus rhythm). The primary outcome was a composite of HF hospitalization, heart transplant, and all-cause mortality.

Results
We included 212 patients 76.9% male and with a mean age of 55.4±10.9 years-old. The most frequent aetiology was dilated cardiomyopathy (43.9%) followed by ischaemic heart disease (38.7%). Accordingly, the mean left ventricle ejection fraction was 29±13%. Additionally, 39.8% had atrial fibrillation. The most used exercise protocol was the modified Naughton (76.6%). Mean pVO2 was 16.7±5.9mL O2·kg−1·min−1, median VE/VCO2 slope was 37.5 [32.7-44.3], and PETCO2L 33.5±5.2mmHg. Mean VP was 3.46±1.31mmHg while the median CP was 1927 [1427-2697]mmHg·min/mL/kg. The mean MVS was 116.2±23.1. Despite weak, there were significant positive correlations between the MVS and both VP (r=0.59, p&lt;0.01) and CP (rs=0.64, p&lt;0.01). After a median follow-up of 71 [49-81] months, the primary outcome occurred in 66.0% of patients (rehospitalization, heart transplant, and all-cause death occurred in 56.1%, 25.9%, and 32.5%, respectively). The new CPET MVS was associated with the primary outcome (p&lt;0.01). Additionally, patients with MVS &lt;120 had a higher rate of the primary outcome (83.2% vs. 39.1%, p&lt;0.01). Kaplan-Meier estimates of tthe primary outcome according to the optimal cut-off value of 120 are shown in Figure 1A. Receiver operating characteristic curve revealed that the MVS has higher discriminative power for the primary endpoint (AUC 0.80, p&lt;0.01) compared to pVVO2, VP, and CP (Figure 1B).

Conclusion
The novel multivariable score is associated with the composite of HF hospitalization, heart transplant, and all-cause mortality in patients with heart failure, enhancing the role of CPET in risk stratification.
Clinical characteristics of patients with cardiac sarcoidosis who were hospitalized for heart failure
Authors: Sakamoto T , Kitai T , Yoshii T , Yaku H , Kato T , Nakagawa S , Irie Y , Moriuchi K , Amano M , Amaki M , Kanzaki H , Kimura T , Izumi C 
Published: November 2023

Abstract

Background
Cardiac sarcoidosis (CS) often leads cardiac dysfunction and exacerbates heart failure. However, there are limited data regarding CS patients who were hospitalized for acute heart failure (AHF).

Purpose
We aimed to compare the patient characteristics and outcomes between patients with CS who were hospitalized for AHF (CS-AHF) and patients with AHF of other etiology.

Methods
A total of 4,556 hospitalized patients with CS were identified from the Japanese Diagnosis Procedure Combination database from 2012 to 2020. Among them, we analyzed 254 patients who were hospitalized due to AHF. Patient characteristics, prior medical history, medical therapy for heart failure, intensive care management during hospitalization, in-hospital outcomes and rehospitalization within one year after the index hospitalization were compared with general 4,056 hospitalized AHF patients who were enrolled in the Kyoto Congestive Heart Failure registry.

Results
Patients with CS-AHF were younger (71 [63-78] vs 80 [72-86]) and more women (69% vs 45%; p &lt; 0.001) than general AHF patients. In addition, CS-AHF were associated with lower prevalence of hypertension, diabetes and dyslipidemia (46% vs 72%, p &lt; 0.001; 28% vs 37%, p = 0.005; and 21% vs 38%, p &lt; 0.001), and lower prescription of angiotensin converting enzyme inhibitors or angiotensin II receptor blocker (28 % vs 46%; p &lt; 0.001) while prescription of beta-blockers were similar between the groups. The length of hospital stay was significantly longer in CS-AHF (23 [14-39] days vs 16 [11-25] days), more patients were treated by intensive respiratory care (32% vs 25%; p = 0.05) and cardiac resynchronization therapy defibrillator (CRTD) implantation (6% vs. 0.5%; p &lt; 0.001) Although in-hospital mortality was similar between the groups, the rate of rehospitalization within one year was higher in CS-AHF (51% vs 39%; p = 0.001).

Conclusions
Patients with CS-AHF were younger, more women and had lower cardiovascular risk factors than those with AHF in general. CS-AHF were associated with longer hospital stay, higher rate of CRTD implantation and higher rehospitalization rates. More attention might be needed for this distinct group of patients.
Is a change of the current echocardiographic red flag for left ventricular wall thickness useful in cardiac amyloidosis screening?
Authors: Ungericht M , Messner M , Sappler N , Zaruba M M , Poelzl G 
Published: November 2023

Abstract

Background
Cardiac amyloidosis (CA) is a serious and progressive infiltrative cardiomyopathy caused by the extracellular deposition of amyloid fibrils in the myocardium. As new disease-modifying therapies are increasingly emerging, prompt and specific diagnosis is fundamental to avoid treatment delay. Echocardiography is the most often used first-line imaging tool for amyloidosis screening. Left ventricular (LV) wall thickness ≥12 mm and age ≥65 years are major criteria for the suspicion of CA. However, it is very likely that many patients, especially in the early stages of the disease, will not be detected. Reducing the diagnostic wall thickness threshold will certainly increase the sensitivity of the amyloidosis screening. It is to be feared, however, that reduction of the cut-off will lead to a large number of patients being unnecessarily subjected to further testing, and substantially increase costs.

Objective
We investigated the distribution of interventricular septum thickness (IVS) in patients referred for routine echocardiography with the aim of establishing a wall thickness cut-off value that is assumed to be suitable for targeted amyloidosis screening.

Methods
We retrospectively analysed the echocardiographic reports from August 2021 to December 2021 at our department. Individual IVS values were documented and categorised. This was to give an idea of how many patients were potentially eligible for further amyloidosis screening solely due to changes in the echocardiographic IVS cut-off value.

Results
1.007 echocardiographic reports were analysed. Of these, 900 included a valid IVS value, while 107 (mainly exclusions of pericardial effusion) did not. From IVS ≥15 mm (5.4%), to ≥14 mm (10.0%), to ≥13 mm (18.6%), to ≥12 mm (32.0%) an increase in patient number was recorded (Figure 1). With regard to CA diagnosis, it can be assumed that systematic screening of patients with IVS ≥12 mm will certainly result in increasing sensitivity but in turn decreasing specificity. On the basis of the patient number within each IVS category we conclude that amyloidosis screening of patients with an IVS ≥13 mm is feasible and reasonable.

Conclusion
We herein conclude that an IVS ≥13 mm should result in targeted amyloidosis screening. In case of IVS &lt;13 mm the use of further red flags is recommended to avoid unnecessary amyloidosis screening and disproportionate increase in costs.
A review of current landscape and definition of septic cardiomyopathy
Authors: Sivapathan S , Gehardy B , Pathan F , Orde S , Negishi K 
Published: November 2023

Abstract

Background
Septic cardiomyopathy (SCM) is a reversible myocardial dysfunction that is increasingly recognised in critically-ill septic patients. SCM and sepsis cause significant morbidity and mortality. However, the lack of consensus on the diagnostic criteria for SCM makes it difficult to understand how sepsis can impact cardiac function.

Purpose
To review the current literature regarding SCM and compare the various proposed diagnostic criteria and imaging parameters utilised.

Method
This literature review comprised of a three-part research method: patient population, imaging modality, and outcomes. Our patient population included critically ill patients diagnosed with sepsis or septic shock. We analysed all cardiac imaging modalities, including TTE, TOE, CT, and CMR. Our outcome was mortality or any related terms. We conducted a comprehensive search of PubMed, EMBASE, and SCOPUS and manually searched for past reviews on the subject. We excluded conference abstracts, review articles, and duplicates using Covidence. Only English-language, adult-audience articles were considered, and the last search update was in November 2022.

Result
This study analysed 77 papers on SCM, of which 55 were prospective and 18 were retrospective (figure 1). The majority of research was conducted in the ICU, and 61 studies used TTE as the primary imaging modality for assessing SCM. Approximately 44% of the studies evaluated cardiac dysfunction in septic patients using systolic function as the primary metric. About half of the research lacked a clear definition of SCM, and 49% did not provide a definitive LVEF cut-off point (figure 2). 78% of the studies determined the reversibility period to be between 7 and 10 days. The majority of studies required that SCM be diagnosed within 24 hours. However, 66% of the studies did not include any type of imaging follow-up for septic patients with cardiac dysfunction.

Conclusion
The heterogeneity inherent among these studies points toward the lack of standardisation in measurements and use of various parameters to assesses cardiac dysfunction in septic patients. There is a need for a new definition of SCM that may be better suited to describing the spectrum of cardiac dysfunction in patients with severe sepsis. Further work is required to establish a consensus definition of SCM and a standardised diagnostic approach.Figure 1Figure 2
Fractional excretion of urea nitrogen can identify true worsening renal function in patients with acute heart failure
Authors: Watanabe Y , Kubota Y , Nishino T , Tara S , Kato K , Hayashi D , Tachibana T , Mozawa K , Matsuda J , Miyachi H , Tokita Y , Iwasaki Y , Yasutake M , Asai K 
Published: November 2023

Abstract

Background
Worsening renal function (WRF) often occurs during decongestive treatment in acute heart failure (AHF). Although WRF has previously been associated with worse prognosis, recent studies have revealed that it may not contribute to an unfavorable outcome in the setting of adequate decongestion achieved. Therefore, there is growing interest to identify patients who develop "true WRF" with poor outcomes.

Purpose
Fractional excretion of urea nitrogen (FEUN), which is used to differentiate causes of renal failure, has emerged as a surrogate marker of volume status in patients with AHF complicated by renal dysfunction. Recent study has reported that a low FEUN value (FEUN ≤32.1%) represents intravascular dehydration, whereas a high FEUN value (FEUN &gt;38.0%) reflects intravascular congestion, both being independent adverse prognostic factors. Therefore, we hypothesized that FEUN could identify "true WRF" in patients with AHF.

Methods
We examined 801 hospitalized patients with AHF and renal dysfunction (defined as discharge estimated glomerular filtration rate &lt;60 mL/min/1.73 m²) whose FEUN was measured at discharge. The patients were divided into four groups as follows: no WRF (n=683); WRF with low FEUN (≤32.1%) (n=36); WRF with medium FEUN (&gt;32.1% and ≤38.0%) (n=25); and WRF with high FEUN (&gt;38.0%) (n=57). WRF was defined as an increase in serum creatinine ≥0.3 mg from admission to discharge. FEUN was calculated by the following formula: (urinary urea × serum creatinine) × 100 / (serum urea × urinary creatinine). The primary endpoint was the composite of all-cause death and heart failure (HF) readmission within 1-year after discharge.

Results
Regarding baseline characteristics, the WRF with low FEUN group had lower left ventricular ejection fraction, whereas the WRF with high FEUN group had poorer renal function. During the median follow-up period of 300 days, 18 all-cause deaths and 165 HF readmissions occurred. Kaplan–Meier analysis showed that patients without WRF had a significantly higher event-free survival rate than those with WRF. In addition, the WRF with medium FEUN group had a significantly higher event-free survival rate similar to that of the no WRF group, whereas the WRF with low FEUN and WRF with high FEUN groups had lower event-free survival rates. In multivariable Cox regression analysis, the WRF with low FEUN (hazard ratio, 1.91; 95% confidence interval, 1.02–3.57; P=0.043) and WRF with high FEUN (hazard ratio, 1.71; 95% confidence interval, 1.02–2.89; P=0.043) groups were independently associated with poor outcomes, even after adjusting for confounders.

Conclusion
Our study suggests that FEUN can identify prognostically relevant WRF and may be a useful marker for guiding decongestive therapy in patients with AHF complicated by WRF.Table 1Figure 1
Clinical effect of renal dysfunction on diagnostic and prognostic accuracy of B-type Natriuretic Peptide and N-terminal Pro-B-type Natriuretic Peptide for acute heart failure
Authors: Wussler D , Balkin M , Michou E , Sabti Z , Kozhuharov N , Strebel I , Nowak A , Von Eckardstein A , Pfister O , Breidthardt T , Mueller C 
Published: November 2023

Abstract

Background
Acute heart failure (AHF) continues to have unacceptable high rates of mortality and morbidity. Therefore, accurate and rapid diagnosis of AHF is crucial for the early initiation of effective treatment. Previous studies have shown that plasma concentrations of B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) increase with declining renal function and that renal dysfunction seems to decrease the accuracy of BNP and NT-proBNP in the diagnosis of AHF.

Purpose
We aimed to directly compare the diagnostic and prognostic accuracy of BNP and NT-proBNP in patients presenting with acute dyspnea, including the effect of renal function.

Methods
This prospective diagnostic study enrolled unselected patients presenting with acute dyspnea to the emergency department. The final diagnosis was centrally adjudicated by two independent cardiologists using all information including imaging and follow-up. BNP and NT-proBNP plasma levels were determined at presentation. 360 days all-cause mortality was the primary prognostic end point.

Results
Among 1579 patients, acute heart failure (AHF) was the adjudicated final diagnosis in 865 patients (54.8%). Plasma concentrations of both BNP and NT-proBNP were significantly higher in AHF as compared to other causes of acute dyspnea (both p&lt;0.001). Diagnostic accuracy as quantified by the area under the receiver-operating-characteristics curve (AUC) was 0.948 (95% CI 0.938-0.958) for BNP as compared to 0.921 (95% CI 0.908-0.935) for NT-proBNP, p&lt;0.001. The diagnostic superiority of BNP was consistent among predefined subgroups according to renal function and increased with the extent of renal dysfunction (Figure 1: all patients (A), patients with eGFR≥ 60 ml/min/1,73 m² (B), patients with eGFR 30-59 ml/min/1,73 m² (C), patients with eGFR &lt;30ml/min/1,73 m² (D)).
In contrast, prognostic accuracy for the prediction of death at 360 days was higher for NT-proBNP (AUC 0.731, 95% CI 0.702-0.760 versus 0.706, 95%CI 0.676-0.736 for BNP; p&lt;0.001). The diagnostic superiority of NTproBNP was consistent among predefined subgroups according to renal function but decreased with the extent of renal dysfunction.

Conclusion
In patients with acute dyspnea, BNP and NT-proBNP at presentation both have very high diagnostic accuracy for AHF and moderate prognostic accuracy for death. There is a numerically small, but statistically and possibly also clinically significant diagnostic superiority of BNP and prognostic superiority of NT-proBNP.Diagnostic accuracy for AHF