bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anthracycline therapy induces an early decline of cardiac contractility with transient edema in low risk patients with breast cancer
Authors: Voss F , Nienhaus F , Pietrucha S , Melz T , Cramer M , Haberkorn S M , Ruckhaeberle E , Fehm T , Floegel U , Westenfeld W , Scheiber D , Jung C , Kelm M , Polzin A , Boenner F 
Published: November 2023

Abstract

Background
Cancer therapy-related cardiac dysfunction (CTRCD) is a dreaded complication of anthracycline therapy in the treatment of breast cancer. CTRCD most frequently appears in patients with cardiovascular risk factors or known cardiovascular disease. There is limited evidence of incidence and prospective course of anthracycline-induced CTRCD in young patients without common risk factors for CTRCD.

Purpose
To longitudinally investigate a cohort of young women on anthracycline treatment due to breast cancer without cardiovascular risk factors or known cardiovascular disease.

Methods
59 women with first-diagnosed breast cancer and planned anthracycline regime-based therapy were enrolled. Exclusion criteria were cardiovascular risk factors or known cardiovascular disease. We conducted a longitudinal assessment before, immediately after- and 12 months after cancer therapy with general laboratory, electrocardiograms, echocardiography and cardiovascular magnetic resonance (CMR), including myocardial relaxometry with T1, T2 and extracellular volume mapping.

Results
Every single patient experienced a drop in CMR-measured left ventricular ejection fraction (LVEF) of 6 ± 3 % immediately after cancer therapy. According to the novel definition 32 patients (54.2%) developed CTRCD after 12 months defined by reduction in LVEF, global longitudinal strain (GLS) and/or biomarkers elevation (Figure 1). LVEF reduction was accompanied by a decrease in stroke volume and cardiac power index while enddiastolic volume index remained stable. Global myocardial T2 relaxation times as well as myocardial mass increased coincidently with a decline in wall-thickening. While T2 values and myocardial mass normalized after 12 months, LVEF and GLS remained impaired.

Conclusion
Among breast cancer patients without pre-existing risk factors for CTRCD anthracyclines induce a decline of myocardial contractility in every single patient, which may lead to an increased risk of future cardiovascular diseases in these patients.
Figure 1: Patients with diagnosed CTRCD directly after CT and after 12 months follow up stratified by underlying CTRCD criteria. Boldness of arrows proportionally represents the number of patients changing between the criteria. Some patients fulfilled more than one criterium for CTRCD.Graphical Abstract Figure 1
Pre-diabetes is associated with increased cardiac events in cancer patients prescribed anthracyclines
Authors: Cheang I F , Zhu X , Huang J Y , Tse Y K , Yiu K H , Li X L 
Published: November 2023

Abstract

Background
Pre-diabetes, a precedent of overt diabetes and metabolic disorder, is a known risk factor for adverse cardiovascular outcomes. Its impact on adverse cardiovascular outcomes in cancer patients prescribed anthracycline-containing chemotherapy (ACT) is uncertain.

Objective
To evaluate the association of pre-diabetes with cardiovascular events in cancer patients prescribed ACT.

Methods
We included cancer patients treated with ACT from 2000-2019, drawn from a previously validated territory-wide database. Patients were subsequently divided into diabetes, pre-diabetes, and normoglycaemia groups based on their baseline glycaemic profile. The primary outcome, major adverse cardiovascular events (MACE), was defined as a composite of hospitalization for heart failure and cardiovascular death.

Results
Among 12649 patients treated with ACT (55.5% male, median age 62 years), 3997 had pre-diabetes at baseline and 5622 had diabetes. Over a median follow-up of 8.7 years, the incidence of MACE was 211 (7.0%) in the normoglycaemia group, 358 (9.0%) in the pre-diabetes group, and 728 (12.9%) in the diabetes group. Compared with the normoglycaemia group, both pre-diabetes (adjusted hazard ratio [HR] = 1.20, 95% confidence interval [CI] 1.01-1.43) and diabetes (adjusted HR = 1.46, 95% CI 1.24-1.70) were associated with an increased risk of MACE. In the pre-diabetes group, 475 (18%) patients progressed to overt diabetes and exhibited a greater risk of MACE (adjusted HR = 1.76, 95% CI 1.31-2.36) than those who remained prediabetic.

Conclusions
In cancer patients treated with ACT, pre-diabetes at baseline, and those who progressed to diabetes at follow-up, had an increased risk of MACE. Our findings reveal that pre-diabetes is a key predictor and potential treatment target to reduce the risk of MACE in patients prescribed ACT.
SARS-COV2 infection and heart failure an intricate link of mutual impact
Authors: Cabac-Pogorevici I , Revenco V 
Published: November 2023

Abstract

Introduction
COVID-19 became an unprecedented global challenge affecting all fields of medicine, though being initially considered a respiratory disease, it has rapidly become clear the multiorgan involvement of the disease. The aim of our study was to assess the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia).

Methods
The research included 178 patients COVID-19, admitted to the cardiology department 18-83 years, the mean age being of 67,23 ± 13,20 years, whereas 47% (84 pts) were men and 53% (94 pts) were women. All subjects underwent physical examination, ECG and echocardiography. The following laboratory parameters were collected: haemoglobin, leukocytes (lymphocytes and neutrophils), platelets, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T or I, C-reactive protein (CRP), procalcitonin, arterial blood gases (pCO2, lactate), aspartate aminotransferase (AST), alanineaminotransferase (ALT), albumin, creatinine for calculation of eGFR, serum sodium and potassium, D-dimers, and international normalized ratio (INR).

Results
Of all patients in the CVDRF cohort, 26 (15%) patients experienced, HF events at admission or during hospitalization, of which 80 (46%) patients in the HF subgroup and 14 (8%) in the non-HF subgroup, the latter accounting for 40% of all observed HF events. In the CVDRF cohort, patients with an HF event were at a two-fold increased risk for in-hospital mortality compared with those without HF events, P &lt; 0.001, OR 3.10 [2.24–4.29]), even after adjustment for age, sex, risk factors, and co-morbidities. Interaction for HF events and age was significant (P = 0.023), with an OR for HF events and in-hospital death of 3.41 (95% CI [1.96–5.93], P ≤ 0.001) in the &lt;75 years age group and 2.82 (95% CI [1.71–4.65], P &lt; 0.001) in the ≥75 years age group. There was no significant interaction between HF events and sex (P = 0.58). Age, CV diseases, CV risk factors, history of HF, atrial fibrillation, and CKD were significantly associated with HF events.

Conclusions
Hospitalized COVID-19 patients with HF are at increased risk for in-hospital death. In-hospital worsening of HF or acute HF de novo are common and associated with a further increase in in-hospital mortality.
Impaired left atrial reservoir function associated with large v wave in patients with transthyretin amyloid cardiomyopathy
Authors: Yamamoto M , Takashio S , Morikawa K , Oike F , Usuku H , Tsujita K 
Published: November 2023

Abstract

Background
Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis (ATTR-CM). Two-dimensional speckle tracking echocardiography is a useful technique for quantitative assessment of LA stiffness. A large v wave on pulmonary artery wedge (PAW) pressure waveform is the findings suggesting LA overload and impaired LA reservoir function. Although large v waves on PAW pressure waveforms are sometimes observed in ATTR-CM patients, their hemodynamic background and clinical significance have not been well described.

Purpose
To investigate the clinical importance of LA function obtained by echocardiography and PAW pressure waveform and the association of enhanced large PAW v wave to clinical outcomes in ATTR-CM patients.

Methods
We retrospectively analyzed central hemodynamics in 136 ATTR-CM patients without severe mitral regurgitation. Large v wave was defined 10 mmHg above mean PAW pressure. We divided 136 ATTR-CM into large v wave group (n = 27) and non-large v wave group (n = 109), and compared the differences in baseline parameters and echocardiographic parameters.

Results
Patients in the large v wave group showed higher mean PAW pressure (24mmHg vs. 14mmHg, p&lt;0.0001). There were no significant differences in age, prevalence of atrial fibrillation, high-sensitivity cardiac troponin T levels (0.060 ng/ml vs. 0.044 ng/mL, p = 0.341), B-type natriuretic peptide levels (188.3 pg/ml vs. 178.7 pg/mL, p = 0.386). In addition, LV ejection fraction, LA diameter, E/e` and cardiac index showed no significant differences between the two groups. However, LA peak longitudinal strain (LS) and LS rate (LSR), evaluation of LA reservoir function, expressed significant depression in large v wave group (LS: 6.24 % vs 9.21 %, p&lt;0.0001, LSR: 0.29 1/s vs 0.38 1/s, p = 0.005).

Conclusions
In ATTR-CM patients, the impaired LA reservoir function associated with extent of large v wave on PAW pressure. This result suggested that impaired LA function may be useful for assessing the progression of ATTR-CM and the deterioration of central hemodynamics.
Ventricular dysfunction after permanent pacemaker implantation in children - what are the implications?
Authors: Bhattacharya D , Namboodiri N , Nair K K M , Dharan B S 
Published: November 2023

Abstract

Introduction
Children (&lt;18 years of age) account for less than 1% of patients requiring permanent pacemaker implantation (PPI), but form a complex subset of population due to technical difficulties, higher prevalence of structural abnormalities and higher rates of reinterventions. Post-pacemaker ventricular dysfunction is seen in around 10-15% and is related to the electrical and mechanical ventricular dyssynchrony. However, similar data is lacking from patients who underwent permanent pacemaker implantation below 18 years of age.

Methods
We retrospectively analysed 235 patients who underwent PPI below 18 years of age, for development of ventricular systolic dysfunction, defined by ejection fraction below 50% of the systemic ventricle.

Results
Male: female ratio was 1.1:1, with median age of implantation being 7 years. 43.4% underwent epicardial PPI, and the commonest indication being congenital complete heart block (50.2%) followed by post-operative CHB (28.1%). 65.5% underwent VVI pacemaker implantation. 41.3% had associated congenital heart disease out of which ventricular septal defect was commonest (20.6%) followed by atrial septal defect (18.6%). Over a median follow-up of 8 years, 15 (6.38%) patients developed ventricular dysfunction, with systemic ventricle of RV morphology, younger age at implantation, maternal ANA positivity, presence of post-operative CHB, associated congenital heart disease and epicardial PPI being major predictors. Five (2.1%) patients required hospitalization for heart failure, while 2 underwent upgradation to CRT. Those with ventricular dysfunction had higher mortality than those who had normal ventricular dysfunction (40% vs 1.5%, p &lt;0.01). There was no association of ventricular dysfunction with the duration of pacing (p = 0.25), the percentage of pacing (p = 0.25) or number of chambers paced (p = 0.38).

Conclusion
Ventricular dysfunction is seen in 6.38% of patients who underwent PPI below 18 years of age, over a median duration of 8 years. It was associated with higher mortality, while younger age at implantation, maternal ANA positivity, presence of post-operative CHB, associated congenital heart disease and epicardial PPI were major predictors for development of ventricular dysfunction.
DDX5 maintains cardiac function by regulating CamkII delta alternative splicing
Authors: Jia K , Zhuang L , Ma W , Cheng H , Li H , Li Z , Wang Z , Sun H , Cui Y , Zhang H , Xie H , Lu L , Gao L , Zhang R , Yan X 
Published: November 2023

Abstract

Background
Heart failure (HF) is a leading cause of morbidity and mortality worldwide. RNA-binding proteins are identified as regulators of cardiac disease. Dead-box protein 5 (DDX5) is a master regulator of many RNA processes, though its functions in heart physiology and disease remain unclear.

Purpose
To elucidate the function of DDX5 in HF and the mechanisms underlying its role in regulating alternative splicing.

Methods and Results
We screened transcriptome databases of murine HF and human dilated cardiomyopathy samples and found that DDX5 was significantly downregulated in both. Cardiomyocyte-specific deletion of Ddx5 resulted in HF with reduced cardiac function, an enlarged heart chamber, and increased fibrosis in mice. Ddx5 overexpression improved cardiac function and protected against adverse cardiac remodeling in mice with transverse aortic constriction-induced HF. Furthermore, proteomics revealed that DDX5 is involved in RNA splicing in cardiomyocytes. By integrating alternative splicing analysis and RNA immunoprecipitation sequencing data, we identified that DDX5 regulated the aberrant splicing of CamkIIδ, thus preventing the production of CaMKIIδA and maintaining Ca2+ homeostasis. In line with this, we found an increased intracellular Ca2+ transients and increased sarcoplasmic reticulum Ca2+ content in DDX5 depleted cardiomyocytes.

Conclusions
Our findings reveal a role for DDX5 in maintaining calcium homeostasis and cardiac function by regulating alternative splicing in cardiomyocytes.
Deep learning model to identify potential occurrence of reduced LVEF in patients with implantable loop recorders
Authors: Howard J , Vasudevan N , Landman S , Sarkar S , Keene D 
Published: November 2023

Abstract

Background
Early detection of left ventricular systolic dysfunction (LVSD) using minimally invasive electrocardiographic assessment in an ambulatory setting may be important considering the increasing economic burden of HF. Recently artificial intelligence (AI) algorithms have been reported to classify reduced ejection fraction using snapshot 12-lead ECG measurements, however the ability of AI to identify LVSD using only a single lead ambulatory ECG is unknown.

Purpose
We aimed to develop a convolution neural network (CNN) based deep learning algorithm using single lead ECG to predict ejection fraction less than 40% in ambulatory patients implanted with implantable loop recorders (ILRs).

Methods
We linked ILR patients with LVEF measurements from a de-identified database of aggregated electronic health record (EHR) data during the period of 2007-2021 to a manufacturer’s device database with ambulatory single lead ECGS. The routine ECG transmissions from the ILR devices were paired with LVEF measured within a week. The data was pre-processed to obtain the time-frequency components of ECG using wavelet transform. The wavelet coefficients were then used as input to train and validate a 2D-CNN model. An independent test dataset consisting of data from patient not included in training/validation dataset was used to assess the performance of CNN model to classify LVEF&lt; = 40% using the metrics area under the curve (AUC), sensitivity and specificity.

Results
A total of 35,741 unique LVEF-ECG pairs collected from 2,249 ILR patients were used to train the model; an independent validation dataset consisted of 6,721 unique LVEF ECG pairs from 750 patients and independent test dataset consisted of 6,611 unique LVEF ECG pairs from 750 patients. In our CNN model, cross entropy was used as loss function and adaptive moment estimation (ADAM) was used as the optimizer. The initial learning rate was selected as 0.0001, epochs as 20 and mini batch size as 64. The threshold to delineate reduced ejection fraction (LVEF&lt; = 40%) was set as 0.1 (Figure 1). The model yielded accuracy, sensitivity, specificity, AUC of 75%,70%, 76% and 0.8 respectively in the independent test set (Figure 2).

Conclusion
A deep learning algorithm applied to ambulatory single lead ECGs acquired by ILR can detect LVEF&lt; = 40%. This continuous ambulatory AI-ECG monitoring may allow to identify longitudinal changes in LVEF post ILR implant via remote monitoring.Figure 1:Model output vs Actual EF rangeFigure 2:ROC
Effects of percutaneous coronary intervention on improvement of left ventricular ejection fraction among chronic coronary syndrome patients with left ventricular systolic dysfunction
Authors: Qiao L , Yibo H E , Hongyu L U , Ziyou Z H O U , Jiulin L I U , Jin L I U , Yong L I U , Jiyan C H E N 
Published: November 2023

Abstract

Background
At present, the therapeutic effects in response to percutaneous coronary intervention (PCI) in chronic coronary syndrome (CCS) patients with left ventricular systolic dysfunction (LVSD) remain unclear.

Methods
Based on the Cardiorenal ImprovemeNt (CIN) cohort study (NCT04407936), we analyzed data of 468 hemodynamically-stable CCS patients with LVSD accepting guideline-directed medical therapy (GDMT) from January 2007 to December 2018. The primary outcome was the improvement of left ventricular ejection fraction (LVEF) and long-term cardiac death. The association between PCI treatment combined with GDMT (PCI-GDMT) and LVEF improvement was evaluated by using propensity score matching (PSM) and logistics regression analysis.

Results
Of the 468 patients included in the study, 135 (28.8%) with GDMT alone and 333 (71.2%) cases were treated with PCI-GDMT. Patients undergoing PCI showed remarkably more vessel lesions but have better cardiac function. After fully adjusting for confounders, the LVEF among CCS patients with LVSD accepting PCI-GDMT were less likely to improve compared with GDMT alone [after PSM: risk adjusted odds ratio (aOR) 0.48, 95% confidence interval (CI): 0.25-0.88, P = 0.02]. Also, PCI therapy may did not bring significant long-term outcome benefit [all-cause death: risk adjusted hazard ratio (aHR) 1.00, 95% CI:0.62-1.62, P = 0.99; cardiac death: aHR 0.61, 95% CI:0.31-1.24, P = 0.17].

Conclusions
Our cohort suggested that PCI treatment may not favor to the improvement of LVEF and not show significant differences in long-term outcome among hemodynamically-stable CCS patients with LVSD.Central Illustration
Outcomes in patients admitted with diabetic ketoacidosis and heart failure with preserved ejection fraction
Authors: Lukan A , Fatuyi M , Alagbo H , Nduka T , Otulana R , Patel N , Sahni A , Analili M , Illah C 
Published: November 2023

Abstract

Introduction
Diabetic ketoacidosis is a common diabetic emergency requiring admission to the intensive care unit , patient with DKA usually present with profound dehydration secondary to osmotic diuresis and one of the major hallmark of treatment is adequate hydration with normal saline, the aim of this study is to establish the possible outcomes that might occur if a patient who has a background history of Heart failure with preserved ejection fraction with DKA, there are studies establishing a relationship between DKA and heart failure with reduced ejection fraction but none has been done to establish possible outcomes in this patient population and this study aims to bridge that gap.

Methods
We analyzed the National Inpatient Sample (NIS) database from 2018 to 2020. The NIS was searched for hospitalization of adult patients with DKA with and without heart failure with preserved ejection fraction . the outcomes analyzed were in-hospital mortality, Cardiogenic shock, septic shock, acute kidney injury, total hospital charge and length of stay. Multivariate logistic and linear regression analysis were used accordingly to adjust for confounders.

Results
A total of 261,410 patients were admitted for DKA, 7.8% (20,280) had HFPEF and 92.2% (241,130) were without HFPEF, among those with HFPEF 50.9% were female and 49.1% were male while among those without HFPEF 44.5% were female and 55.5% were male, compared with those without HFPEF, patients with HFPEF had a statistically significant increase in in-hospital mortality (1.92% vs 0.65%, p&lt;0.007,OR-1.46, 95% CI 1.10-1.93) Length of stay (5.3 vs 3.6, p value&lt;0.0001, IRR = 1.12, 95% CI 1.08-1.15), septic shock (3.08% vs 1.49%, p value&lt;0.023, OR = 1.27, 95% CI 1.03-1.56), cardiogenic shock (0.9% vs 0.19%, p value&lt;0.0001, OR = 4.6, 95% CI 2.77-7.66) and Total hospital charge ($55583.7 vs $38632.24, p value&lt;0.0001, IRR = 1.15, 95% CI 1.1-1.19), there was no statistically significant difference in acute kidney injury(53.21% vs 44.27% p value 0.09, OR 1.1, 95% CI 0.89-1.23)

Conclusion
This study has been able to establish a significant increase in in-hospital mortality, Length of stay, septic shock, cardiogenic shock and total hospital charge in patients with DKA and HFPEF and no difference in the rate of AKI, patients with HFEPF should be considered as a special population when managing DKA and fluid management in this patient population will need further studies.