bluuebunny/crossref_metadata_2025_split huggingface dataset:
Enhancing Quality of Life in Cardiovascular Patients: The Role of Comprehensive Interventions and Cardiac Rehabilitation
Authors: Almeida Carvalho S , Costa C , Fernandes A , Adrega T , Albuquerque N , Neves A , Mesquita Bastos J 
Published: November 2023

Abstract

Introduction
Cardiac rehabilitation is an established strategy to improve cardiovascular outcomes in patients with Acute Coronary Syndrome (ACS) and Heart Failure (HF). However, not all patients can participate in such programs. Intermediate interventions focused on lifestyle modification may be a potential strategy to improve outcomes. Depression and anxiety are common in patients with CVD and are linked to increased mortality. The Hospital Anxiety and Depression Scale (HADS) is a 14-item tool used to measure anxiety and depression symptoms and has been shown to be useful in assessing the psychological well-being of patients undergoing cardiac rehabilitation.

Objective
The objective of this retrospective study was to evaluate the impact of different levels of intervention on the quality of life of patients after cardiovascular events - ACS and CHF - in terms of depressive and anxious outcomes.

Materials and Methods
The study analyzed 56 patients who were previously hospitalized in the Cardiology department within one year: 47 for ACS and 9 for decompensated HF. After discharge, 19 patients attended a cardiac rehabilitation program (group 1), 19 had regular cardiovascular risk appointments and educational sessions conducted by psychiatrists, nutritionists, physiatrists, and cardiologists, but without participating in a physical rehabilitation program (group 2), and 18 patients were selected as controls without any of previous strategies (group 3). The group 1 intervention include also the measures implemented in group 2. All participants signed informed consent and completed the HADS questionnaire.

Results
The average age of the participants was 54.9 ± 9.9 years, with 29% females, and an average of 2.7 ± 0.6 cardiovascular risk factors. There were no significant differences in the distribution of ACS or decompensated heart failure between the groups. Group 1 predominantly presented a normal pattern of HADS scores (56% vs 40% vs 4%), respectively for group 1, 2 and 3. Conversely, in group 3 compared with group 1 and 2, there was a predominance of the abnormal score, respectively (50% vs 17% vs 33.3%); p &lt;0.01.

Conclusion
The results suggest that patients who underwent regular appointments/education and cardiac functional rehabilitation exhibited lower levels of anxiety and depressive symptoms.
In conclusion, the study indicates that a comprehensive intervention continuum, including cardiac rehabilitation and regular appointments/education, can significantly improve patients' quality of life and reduce their cardiovascular risk. Patients who undergo cardiac rehabilitation may experience the greatest benefits. The findings support the potential value of intermediate interventions focused on lifestyle modification as a strategy to improve outcomes for patients who cannot participate in a rehabilitation program.
Prognostic role of data transmitted by implanted cardiac electric devices in patients with advanced heart failure referred for heart transplantation
Authors: Aloisio A , Marchi F , Ziacchi M , Masetti M , Massaro G , Frisoni J , Corrado M C , Borgese L , Sabatino M , Biffi M , Diemberger I , Potena L 
Published: November 2023

Abstract

Background
Patients (pts) with advanced heart failure (HF) are poorly tolerant to GDMT, frequently hospitalized and are often carriers of implantable cardioverter-defibrillators (ICD) or of cardiac resynchronization therapy (CRT-D). These devices allow HF centers to remotely monitor the occurrence of arrhythmic events and of ICD interventions, such as anti-tachycardia pacing (ATP) bursts or DC-shocks. While HF hospitalizations are an established prognostic marker, the role of remote monitoring in a context of pts referred for heart transplantation (HT) is poorly explored.

Purpose
In this retrospective monocentric study we aim to evaluate the prognostic value of remotely-transmitted information from ICD/CRT in pts with advanced HF followed in a tertiary Center dedicated to HF and HT.

Methods
We included all adult pts with a remotely transmitting device followed by both Electrophysiology and Heart Failure Teams in our Center between September 2016 and January 2023. We collected data about heart disease, medical therapy, echocardiography, device-delivered therapies, and hospital admissions for any cause. The outcome was the combined incidence of death from any cause or urgent heart transplantation.

Results
123 pts were enrolled ( 57±10 yrs, 75% males, LVEF 34%±10%). 68 had an ICD, 55 CRT-D. 50 pts (41%) received at least one device-delivered therapy (34 pts had at least one ATP; 29 pts had at least one DC-shock, of whom 26 were appropriate). During a mean follow-up of 29 months, we recorded 121 hospitalizations (53% for arrhythmias, 47% for acute HF) in 44 pts. The endpoint occurred in 14 pts : 12 (9.8%) died, 2 (1.6%) underwent to urgent HT; overall, 12 pts (9.8%) were transplanted. Pts with arrhythmic events had more frequently a spontaneous QRS &gt;120ms (60% vs. 40%, p=0.04) and a trend towards more hospitalizations for heart failure (64% vs. 35%, p=0.059). The predictor of the combined endpoint of death or urgent transplant was hospitalization for HF (RR: 4.2, p&lt;0.01); ATP and/or DC-shocks (RR 7.3) and intolerance to vasodilators (ACE-I, ARB, ARNI), (RR (1.5) showed a borderline statistical significance (p=0.06 for both). However, in the subgroup of patients without any HF hospitalization, device-delivered therapies from ICDs and CRT-D carried an higher risk of death and urgent HT (p=0.03), see Figure .

Conclusion
In a population of patients with advanced HF, while confirming the known prognostic role of HF hospitalization, we found that remote monitoring of ICD shocks/ATP in patients not hospitalized for HF identifies a subgroup of patients at high risk of death or urgent HT. These results underscore the importance of considering these patients for advanced HF therapies and of an integrated approach between electrophysiologists and HF specialists.
Acute deterioration in dyssynchrony and systolic function from Lot-CRT to LBBB pacing
Authors: Tan J , Zhang Q , Kang Y , Luo Y R , Yu S , Feng K 
Published: November 2023

Abstract

Background
Better electrical synchronization and left ventricular (LV) systolic function was recently reported in left bundle branch–optimized cardiac resynchronization therapy ( Lot-CRT ) when compared with conventional CRT. The implantation of left bundle branch pacing (LBBP) is less expensive, easier to operate and has shorter exposure time to X-ray than Lot-CRT.

Purpose
To observe whether there are negative changes in dyssynchrony and LV systolic function when switched from Lot-CRT to LBBP. determine whether LBBP pacing alone can replace CRT therapy.

Methods
30 patients (21 males, 64.4±9.5 years, 43% with persistent atrial fibrillation) who fulfilled the criteria of CRT implantation received Lot-CRT. The right atrial electrode of the patients with atrial fibrillation or the right ventricular electrode of those with sinus rhythm was implanted into the left bundle branch area. After six months, 20 patients whose LV ejection fraction (LVEF) increased by more than 5% and New York Heart Association functional class increased by at least 1 grade were selected for further investigation. Right and left ventricular pacemaker electrodes were programmed to shut off, leaving only the left bundle branch area pacing for one month. The LV size, systolic function, interventricular mechanical delay (IVMD), and LV mechanical dyssynchrony (LVMD) were compared by using two-dimensional speckle tracking echocardiography.

Results
It was found that QRS duration slightly widened, the LA size increased, the LV size slightly increased and LVEF decreased, p&lt;0.05. There was no statistical significance in the IVMD (p=0.064). The LV mechanical dyssynchrony increased significantly, p&lt;0.001.

Conclusions
Deteriotation of LV dyssynchrony and systolic function was recorded when Lot-CRT to LBBP for a short period in recovering patients with systolic dysfunction. It indicates that LBBP may not yet maintain the benefits of Lot-CRT in this group of patients.The comparison between Lot-CRT and LBBP
Comparative study of the effects of left ventricular and biventricular pacing on indices of cardiac function and clinical status of heart failure patients: preliminary results of READAPT study
Authors: Chrysohoou C , Dilaveris P , Xydis P , Kordalis A , Laina A , Kalantzis C , Vouliotis A , Pozios I , Kariori M , Sideris S , Tsioufis C 
Published: November 2023

Abstract

Nonresponse to cardiac resynchronization therapy (CRT) has been related with right ventricular dysfunction. Preferential left ventricular pacing (pLVP) can overcome iatrogenic right ventricular dysfunction by achieving left ventricle resynchronization and by allowing for intrinsic activation of the right side, with ramifications extending beyond cardiac output and atrial fibrillation occurrence. Moreover, the AdaptivCRT® algorithm also automatically adjusts interventricular (V-V) delay every minute, optimizing it by means of comparing relative activation delay between right and left ventricles (electrically – driven optimization).
In the present study we evaluated the effects of a pLVP algorithm on 50 heart failure patients (all Caucasians, 49% male; 66 +/- 8 years old; 46% ischemic cardiomyopathy; 41% diabetics; NYHA II-III) following randomization to standard biventricular pacing and pLVP, on echocardiographic and cardiopulmonary exercise test indices of functional status, as well as a self-reported quality of life questionnaire. Device programming was based on echocardiography-evaluated maximization of stroke volume and subsequent interventricular and atrioventricular delay adjustments delegated to the device. The follow-up consisted of 6 and 12-months visits; after the 1rst month of optimizing maximum CRT response.

Results
Significant comparative effects of LVP over optimized CRT were noted regarding RV systolic velocity in TDI even from 6-months from baseline (6% increase, p=0.01); while end-systolic diameter of left ventricle was increased by 4% in 6-months in CRT group (p=0.01), while no significant difference was observed in LVP group. At 12 months endsystolic volume was significantly decreased (16%, p=0.01) and left ventricular systolic longitudinal strain was improved in 12 months in LVP group compared to CRT group (p- for interaction =0.001). Additionally, in cardiorespiratory exercise test LVP group showed improved inotropic reserve compared to CRT group according to maximum SBP achieved (20% increase, p&lt;0.01 for interaction); while all other cardiorespiratory indices shoed borderline significant changes at 12 -months. Minnesota score was significantly reduced in LV-P group by 70% at 6-months; whereas no significant change was observed in CRT group (p for interaction &lt;0.01).

Conclusions
In the preliminary findings of READAPT study, it seems that LV pacing optimized by a standardized echocardiographic protocol in patients with preserved AV conduction, LBBB, can achieve a higher percentage of synchronized LV pacing associated with improved patient quality of life; right ventricular function and endsystolic volume at 6 and 12-months of follow-up, over echo-optimized CRT pacing.
Does scar burden predict sudden cardiac death in patients with cardiac resynchronization therapy? - A Systematic Review and Meta-Analysis
Authors: Masszi R , Turan C , Zsigmond E , Ehrenberger R , Hegyi P , Fehervari P , Kosztin A , Merkely B 
Published: November 2023

Abstract

Background
Based on latest guidelines, scar burden assessment may have a crucial role in appropriate device choice in cardiac resynchronization therapy (CRT), but no randomized controlled trials have been made yet.1 Scar burden is associated with a higher prevalence of ventricular arrhythmias (VA) and sudden cardiac death (SCD).2 Late gadolinium enhancement cardiovascular magnetic resonance (LGE-CMR) can accurately evaluate the extent of myocardial scar.3.

Purpose
Our aim is to investigate the association between scar burden and SCD risk in cardiac resynchronization therapy patients.

Methods
We performed a systematic literature search on MEDLINE using the PubMed, Embase, Scopus, and CENTRAL databases. Heart failure patients with reduced ejection fraction and CRT therapy were collected. The primary endpoint was sudden cardiac death events. Meta-analyses were performed using the META and DMETAR packages in R, using a random-effects model. The risk of bias was assessed using Quips tool and the quality of evidence was evaluated using the GRADE assessment.

Results
18 eligible articles have been included in our study, with a total of 2917 patients, of whom 830, 1324, and 391 have been implanted with an ICD, CRT-D, CRT-P respectively. Altogether 59,05 % of the total population were LGE-CMR positive. The average proportion of appropriate ICD shock was 15,65 % per the total population during the median follow-up time of 39,45 months. Based on the univariant analysis of 14 articles, the cumulative hazard ratio of developing sudden cardiac death events, in the scar burden positive population compared to scar burden negative was 1,95 with CI: 1,29- 2,96 p&lt;0,001. The multivariant analysis shows the HR of 1,88 with CI: 1,20- 2,93 p&lt;0,001. There were 4 articles using the competing risk model which is considered to be the highest evidence level. Based on that analysis we found only a trend with a HR of 1,55 CI: 0,75-2,92. Calculating from the event numbers based on 8 eligible articles, the high scar burden group had 5.55 higher odds of getting SCD events. (OR: 5.55. CI 2,52-12,22 p&lt;0,001).

Conclusion
In our meta-analysis, LGE-CMR was associated with a trend toward appropriate device therapy and can identify a subgroup of patients with an increased risk of life-threatening VA. Based on our results performing an MRI before device implantation might be important to select high-risk patients for SCD.Forest plot O.R.Forest plot uni. H.R.
CineECG repolarization gradients predict acute hemodynamical response in CRT patients
Authors: Sedova K , Azarov J , Van Dam P , Kautzner J 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) is widely used for patients with conduction disorders and heart failure. The proportion of the CRT-non-responders can exceed 30%, which warrants search for new approaches to optimize the CRT device implantation and follow-up. CineECG is a novel cardiac anatomy-based ECG modality proposed for better visualization of the myocardial depolarization and repolarization processes. This method yielded promising results in patients with sinus rhythm but has not been tested in ventricular pacing.

Purpose
The aim of the present study was to evaluate CineECG-derived mean temporo-spatial isochrone (TSI) trajectory in different pacing protocols and test its association with acute hemodynamical responses in CRT patients.

Methods
CineECG uses a generic heart/torso model to construct the average electrical pathway within the cardiac anatomy from the 12 lead ECG. CineECG and invasive hemodynamical parameters were tested in 15 patients undergoing multisite CRT system implantation. ECG recording and hemodynamical measurements were performed simultaneously, while the patients were undergoing 4-6 biventricular pacing protocols with the same interventricular pacing delay (30 ms) and different left ventricular (LV) lead localizations (apical, basal, multisite). LV dP/dt max was tested for association with the parameters of standard ECG (QRS duration, QT duration, Tpeak-Tend duration) and CineECG pathway parameters. The latter pathway directions were computed for QRS and ST-T intervals for anteroposterior (X), left-to-right (Y), and apicobasal (Z) directions.

Results
Biventricular protocols did not differ between each other in LV dP/dt. In univariate linear regression analysis, LV dP/dt max was associated with QRS and ST-T pathway directions (Figure 1 - table). The left-to-right (Y) and apicobasal (Z) ST-T pathway directions remained independent predictors of LV dP/dt max in multivariate linear regression analysis with the adjustment for a pacing protocol [regression coefficient 571.6 (319.3 – 823.8), p&lt;0.001; regression coefficient -406.9 (-636.7 – -177.2), p=0.001, respectively]. Optimal repolarization sequences associated with better acute hemodynamic responses assessed by LV dP/dt max were from right to left and from base to apex (Figure 2).

Conclusion
CineECG repolarization pathway gradients in the left-to-right and apicobasal directions outperform temporal ECG parameters and predict the acute hemodynamical response in biventricular pacing protocols in CRT patients.
Determinants and differences of delay in cardiac resynchronization therapy
Authors: Gatti P , Lind S , Kristiandottir I , Azari A , Savarese G , Anselmino M , Linde C , Gadler F 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) is recommended for the treatment of heart failure (HF) patients with reduced ejection fraction and left bundle branch block (LBBB) but is still largely underused which may further deteriorate the HF condition. Studying the impact and factors related to delays in CRT with or without an Implantable cardioverter defibrillator (ICD) is fundamental to enhance CRT implementation in clinical practice.

Methods
We used a central ECG database together with National patient registries to identify LBBB patients with a QRS duration of more than 150 ms and estimated a class I indication for CRT based on a registered diagnosis of HF and ejection fraction &lt; 35% (baseline date). We compared patient characteristics in those with CRT-D, CRT without defibrillator (CRT-P) and patients with an indication but without CRT. Factors associated with CRT-P or CRT-D were analyzed as well as factors related to delay in CRT utilization. Outcome parameters were HF hospitalization and combined total and CV mortality and the impact of the delay in CRT utilization on outcome was analysed.

Results
Of 5359 patients with LBBB and QRS &gt; 150ms, 1268 (24%) developed a class I indication for CRT. Of these 31% received a CRT-P, 36% CRT-D and 33% were not implanted. Independent predictors for CRT-P were age &gt; 75 years and for CRT-D ischemic heart failure aetiology, hypertension and male sex. Patients with CRT-D had similar HF hospitalization rate (hazard ratio (HR): 0.95, 95% (CI) 0.80-1.14) as patients with CRT-P. In contrast, patients indicated but not implanted with CRT had a significantly higher prevalence of HF hospitalization (HR: 1.65, CI 1.39-1.96). A delay in CRT use &gt; 365 days (161 patients) from indication (baseline) was associated with increased risk of overall mortality and cardiovascular mortality compared to CRT implantation &lt; 30 days from the indication (HR: 1.64, CI 1.05-2.55 and HR: 1.87, CI 1.10-3.18). Age &gt; 75 years, male sex, paroxysmal atrial fibrillation, diabetes and ischemic heart disease were associated with significant delay in CRT use (&gt;365 days).

Conclusion
In a large real-world setting, delay in CRT implantation was common and associated with increased mortality. The findings suggest a need for new methods to find and treat HF patients with an indication for CRT.
Bridging therapy and risk of major bleeding and thrombosis in continuous-flow left ventricular assist device patients: a quasi-experimental study
Authors: Roovers R P W , Camilleri E , Janssen E , Jukema J W , Palmen M , Van Rein N , Tops L F 
Published: November 2023

Abstract

Background
Bridging with low molecular weight heparin (LMWH) on top of vitamin K antagonist treatment is recommended in continuous-flow left ventricular assist device (CF-LVAD) patients during subtherapeutic anticoagulation. However, the consequence of bridging on the risk of bleeding and thrombosis are unknown.

Aim
To assess the risk of major bleeding and thrombosis associated with bridging in CF-LVAD patients, through a regression discontinuity (RD) design, a quasi-experimental design.

Methods
We included CF-LVAD patients implanted at our university medical center between 2010-2021. Outcomes were major bleeding (INTERMACS type 3, 4, 5) and thromboembolic events (pump thrombosis, arterial non-central nervous system and venous thromboembolism). We estimated incidence rates and hazard ratios (HR) with 95% confidence intervals (95%CI) by time-dependent Cox regression. Using an RD design, a quasi-experimental design, we compared patients using LMWH due to a subtherapeutic international normalized ratio (INR) to patients with no LMWH and an INR just in target range. As LMWH treatment is initiated based on an INR threshold (i.e., when INR is below the lower target range) and INR is subject to random variability, patients just below and in the INR target range are comparable, mimicking a randomized trial. Analyses were performed five times including INRs±0.1, ±0.2, ±0.3, ±0.4 and ±0.5 around the INR threshold.

Results
77 patients were included, with a median age at implantation of 69 years, 60 (78%) were male, 45 (58%) had ischemic heart failure and 35 (45%) had INTERMACS classification 3. We included 35,466 INRs during 91 patient-years of follow-up. Bridging was associated with increased major bleeding rates compared to no-bridging in all analyses (Figure 1). In particular, the risk of major bleeding was 6.9-fold increased (95%CI 1.2-38.9) during bridging compared to no-bridging considering INR+0.1, and 3.4-fold (95%CI 1.4-8.2) considering INR±0.5 (Figure 2A). While thrombotic events were infrequent, the risk of thrombosis was around unity during bridging compared to no-bridging considering INR±0.5 (HR 1.1, 95%CI 0.1-9.9, Figure 2B).

Conclusions
During bridging with LMWH, CF-LVAD patients had a 6.9-fold increased risk of major bleeding, while the risk of thrombosis was around unity compared to no-bridging.Incidence ratesHazard ratios