bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation and utility of the changes in sST2 level at clinician determined decompensation and recompensation
Authors: Li B , Dowley M , Langley S , Hardy-Wallace A , Cliffe P , Whiting S , Dimarco A , Zydik L , Barbagallo R , Dungu J N , Savage H O 
Published: November 2023

Abstract

Introduction
Soluble Suppressor of Tumorigenicity 2 (sST2) biomarker has been shown to demonstrate prognostic capabilities in patients with heart failure (HF), with serial measurements of sST2 at pre-determined time intervals providing additional predictive value for adverse outcomes. We sought to evaluate what level of sST2 level change, at clinician determined decompensation and recompensation during an acute admission for decompensated HF, could provide prognostic information for adverse outcomes.

Methods
Between January 2020 and February 2022, consecutive patients hospitalized at a secondary care hospital had sST2 measured within 24 hours of decompensated HF admission and following recompensation assessed by qualified clinicians, as part of the INST2ANT-HF study. sST2 samples were batched analysed at the end of recruitment period with a quantitative turbidimetric immunoassay. The primary outcome was the interval change between admission and discharge sST2 in patients admitted with decompensated heart failure. Related-samples Wilcoxon signed rank test was performed to evaluate for difference in sST2 at decompensation and recompensation. Comparison of median sST2 change was made using independent samples median test comparing alive and deceased patients at one year follow up.

Results
In 162 consecutive patients with paired samples, median age was 71 (IQR 61-80). 23.5% were female and 34% had an ischaemic aetiology. 94.4% presented with NYHA class III and IV and median ejection fraction was 26% (IQR 17-32). Median length of stay in hospital was 8 (IQR 5-13) days. Median levels of sST2 at decompensation and recompensation were 60.5 and 39.5ng/ml respectively (p&lt;0.001) (Fig.1a). In patients who died within the first year, median levels of sST2, at decompensation and following recompensation, were significantly higher than in patients who were alive. (decompensation sST2 83 vs 56ng/ml; p = 0.007 and recompensation sST2 58 vs 34ng/ml; p = 0.036) (Fig. 1b). There was however no significant difference in the absolute or percentage change in sST2 level between those who died and those who survived (19.5 vs 16ng/ml, p= 0.437; 27 vs 35%, p = 0.363).

Conclusion
Our initial data demonstrates that in a cohort of patients admitted with acute decompensated HF, there was a significant difference in sST2 levels between clinician determined decompensation and recompensation. Higher levels of sST2 at both decompensation and recompensation were associated with a higher risk of mortality at one year. Utilizing newer biomarkers such as sST2 to predict outcomes may allow better risk stratification and identifying patients needing closer follow up. More research is needed however to determine what values would be useful in clinical practice.Figure 1Figure 2
Sex hormone-binding globulin and heart failure hospitalizations in patients with dysglycemia - Experiences from the Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial
Authors: Wang Gottlieb A , Gerstein H , Hess S , Lee S , Mellbin L , Ryden L 
Published: November 2023

Abstract

Background
Sex hormone-binding globulin (SHBG), which binds most of the circulating testosterone in blood, is linked to both dysglycemia and a variety of cardiovascular (CV) events. However, few studies have investigated the link between SHBG and heart failure.

Purpose
To investigate the relationship between SHBG levels and heart failure hospitalizations in men and women with dysglycemia.

Methods
The Outcome Reduction with an Initial Glargine Intervention (ORIGIN) trial followed individuals with dysglycemia (impaired fasting glucose, impaired glucose tolerance or diabetes) and high cardiovascular risk for a median of 6.2 years. Incident CV events, including heart failure hospitalizations (defined as heart failure requiring overnight stay at hospital or attendance in an acute care setting) were collected and adjudicated. A subset of patients (n = 8,494) in whom blood samples were stored had SHBG levels analysed. Cox regression was used to estimate hazard ratios (HRs) of heart failure hospitalizations per standard deviation increase of SHBG. Adjustments were made for age, comorbidities, biochemical data (including testosterone) and pharmacological treatment. Analyses were performed separately in men and women.

Results
A total of 5,553 men and 2,848 women were included in whom heart failure hospitalizations were reported in 349 men and 123 women. Median SHBG levels were 35 nmol/L (25-47) in men and 39 nmol/L (27-55) in women. The primary outcome was more frequent in men with SHBG levels above median (n = 208/349 [59.6 %]; p&lt;0.01) whilst no difference was seen for women (n = 69/123 [56.1%]; p = 0.24). A higher SHBG was associated with increased risk of heart failure hospitalizations in men (adjusted HR 1.15, 95% CI 1.03-1.28; p = 0.011) but not in women (adjusted HR 1.13; 95% CI 0.96-1.39; p = 0.14).

Conclusions
In this biomarker substudy within the ORIGIN trial comprising patients with dysglycemia and at high CV risk, increasing levels of SHBG were associated with heart failure hospitalizations independent of testosterone levels in men but not in women.
Echocardiographic assessment of right heart function in the presence of TR: Is right heart strain the answer?
Authors: Curtis E , Lemarchand L , L'official G , Bourg C , Oger E , Donal E 
Published: November 2023

Abstract

Background
Right heart function is challenging to assess with echocardiography due to the complex anatomy and load dependence. To complicate the assessment, significant tricuspid regurgitation flatters the right ventricle. These complexities have led to the need for other modalities and invasive measures of RV function to complement clinical decision-making and risk profiling. Speckle tracking can assess subtle anomalies and appears to be promising for right heart assessment.
We assessed right heart strain against classic echocardiographic measures of RV function (TAPSE, RVS’ and fractional area change (FAC)) and invasive measures of RV function (right ventricular stroke work index (RVSWI) and Pulmonary Artery Pulsatility index (PAPi)), in patients with severe TR and without, to see strain reclassifies the assessment of RV function from "normal" to impaired and to assess the prognostic value of right heart strain.

Methods
A single-centre retrospective analysis of data from 262 consecutive patients (age 74 ±11.2 years old; male 53%) with both right heart catheterization (RHC) and TTE. Clinical data was gathered from patient files, and outcomes of heart failure hospitalisation or death were recorded. Echocardiographic evaluation was completed on commercially available GE ultrasounds and data was stored on a dedicated workstation for offline analysis (EchoPAC version 112.99). Statistical analysis was performed using SAS 15.1.

Results
Over a median follow up of 34 ±15 months 99 events occurred. 53% of patients had severe TR. RV free wall strain reclassified RV function as impaired in 73% of patients with "normal" RV function as determined by FAC (p value 0.005), and in 71% of patients with normal RVS’ (p value 0.03) with severe TR. Using invasive measures, RVSWI reclassified RV function as abnormal when compared to TAPSE in 53% of patients (p value 0.02). PAPi reclassified RV function as impaired compared to TAPSE in 53% of patients (p value of 0.009).
In patients with TR 3+, right atrial strain reclassified presence of right heart dysfunction in 91% of patients compared to TAPSE &gt;17 (p value 0.01) and in 95% of patients compared to RVS’ (p value 0.004).
In patients with moderate or less TR, RV strain reclassified 66% as having RV dysfunction with normal FAC (p value 0.003) and reclassified 61% of patients with RV dysfunction in patients with a normal RVS (p value 0.03). Invasive measures did not reclassify RV function assessment in patients with moderate or less TR. In patients with and without TR, RV strain and invasive measures were in accordance.
Abnormal RV strain (&gt;-23%) was associated with an adverse prognosis HR 3.63 (1.43 – 9.22).

Conclusion
In the presence of severe TR, right heart strain helps to reclassify RV function, comparable to invasive measures. Abnormal right heart strain is strongly associated with prognosis and its utility should be confirmed in prospective studies.
Predicting heart failure and cardiovascular mortality after myocardial infarction: UCCS-HF risk score
Authors: Trifunovic Zamaklar D , Veselinovic A , Andjelkovic M , Petrovic O , Jovanovic I , Paunovic I , Vratonjic J , Boricic Kostic M 
Published: November 2023

Abstract

In spite of the current effective management of acute myocardial infarction, post-infarction heart failure (post-MI HF) continues to be a significant medical problem, with high morbidity and mortality. The robust risk score based on readily available clinical and echocardiographic data might help to recognize patients at risk and initiate early preventive/treatment strategies for post-MI HF.
The aim of the work: identify clinical and echocardiographic independent predictors of MACE (post-MI HF hospitalization or cardiovascular death) and develop a simplified risk score to predict MACE.

Material and methods
the retrospective study, 330 post-MI patients were initially included. Clinical (age, diabetes mellitus-DM, atrial fibrillation-Afib, chronic kidney diseases-CKD, cerebrovascular insult-CVI and gastro-bleeding) and standard echocardiographic parameters were analyzed.

Results
104 patients have complete data set for analysis and represent final cohort. During the follow-up period (median: 57 months), 24% of them experienced MACE. Significant clinical MACE predictors were: chronic kidney diseases (CKD: HR 1.95, 95% CI 1.124-3.394, p = 0.017) and atrial fibrillation (Afib: HR 2.66, 95% CI 1.522-4.647, p = 0.001). Significant echocardiographic MACE predictors were: left ventricular ejection fraction (EF&lt;40%: HR 2.40, p = 001), right ventricular systolic pressure (RVSP≥33mmHg: HR 4.043, 95% CI 2.104-7.767, p&lt;0.001), left atrial volume (LAVi≥46ml/m2: HR 4.377, 95%CI 1.852-10.348, p = 0.001), deceleration time of transmitral E wave (Dct≤188 ms: HR 4.00, 95%CI 1.739-9.201, p = 0.001), right ventricular diameter (RVd≥26mm: HR 2.056, 95%CI 1.221-3.462, p = 0.007), the systolic velocity of tricuspid annuli (Sm&lt;9.3 cm/sec: 2.068, 95%CI 0.954-4.485, p = 0.006), mitral regurgitation (MR≥2+: HR 3.657, 95% CI 2.079-6.433, p&lt;0.001) and tricuspid regurgitation (TR≥2+: HR 2.824, 95%CI 1.669-4.778, p&lt;0.001). A risk score for post-MI HF or CV mortality (UCCS-HF score) of 10 variables was defined with good discrimination (c-statistic 0.85) (Picture 1).

Conclusion
nearly 1/4 of post-MI patients experienced HF hospitalization or CV death within 5 years after MI. A simplified risk score (UCCS-HF score) merging clinical risk factors (CKD and Afib), and echo variables (parameters of LV systolic function, LV diastolic properties, and RV systolic pressure and function) is a potentially easy, helpful, and robust tool to predict post-MI HF hospitalization and CV death. External validation and on larger patient population is needed.
Impact of diaphragm atrophy in elderly patients with heart failure: a multicenter prospective cohort study
Authors: Kagiyama N , Kamiya K , Toki M , Saito H , Iwata K , Matsue Y , Yoshioka K , Saito K , Murata A , Hayashida A , Kitai T , Maekawa E 
Published: November 2023

Abstract

Background
The diaphragm plays an important role in cardiac and respiratory functions. However, the importance of diaphragm atrophy in patients with heart failure (HF) has not been well described.

Purpose
To assess the feasibility of ultrasound-based assessment of the diaphragm and its prognostic impact in elderly patients with HF.

Methods
We conducted a multicenter prospective cohort study enrolling patients hospitalized with HF aged ≥65 years. Diaphragm thickness at rest and during inspiration was measured with ultrasound before discharge by certified observers, and interobserver variability was assessed using 90 images.

Results
Of the 599 enrolled patients (median 81 [74 - 86] years old, 55% female), mean diaphragm thickness at rest and during inspiration were 1. 9 ± 0.6 and 3.1 ± 1.2 mm, respectively. Interobserver variability was small with an intraclass correlation coefficient of 0.84 (0.76 – 0.89). Patients with thin (&lt; 1.9 mm) diaphragm at rest (n = 304) had smaller body mass index (20.9 ± 3.6 vs 22.2 ± 4.0 kg/m2, p &lt; 0.001), higher NYHA class (class II or higher 78% vs 61%, p &lt; 0.001), lower % forced expiratory volume in 1 second (83.2 ± 22.3% vs 88.7 ± 23.7%, p = 0.013), and lower handgrip strength (18.1 ± 7.3 vs 19.8 ± 8.0 kg, p = 0.009). During the median follow-up of 663 [456 - 882] days, 160 patients died. Kaplan-Meier curve analysis showed significant stratification by quartile groups of diaphragm thickness at rest. After adjustment for the established MAGGIC risk score, diaphragm thickness was significantly associated with all-cause death (hazard ratio 0.56 [0.41 – 0.71] /mm, p &lt; 0.001).

Conclusions
Diaphragm atrophy was prevalent in elderly patients with HF and had a strong association with all-cause death. Further studies are necessary to evaluate the efficacy of interventions.
The effect of sglt-2 inhibitor dapagliflozin on adropin serum levels in patients with chronic heart failure and concomitant type 2 diabetes mellitus
Authors: Berezin A , Fuschtey I M , Berezin A A 
Published: November 2023

Abstract

Background
adropin plays a protective role in cardiac remodeling through supporting energy metabolism and water homeostasis and suppressing inflammation. Low circulating levels of adropin were positively associated with the risk of cardiovascular diseases and type 2 diabetes mellitus (T2DM). We hypothesized that sodium–glucose linked transporter 2 (SGLT2) inhibitor dapagliflosin might represent cardiac protective effects in T2DM patients with known chronic heart failure (HF) through the modulation of adropin levels.

Methods
The study was an open-label, multicenter non-randomized cohort investigation. Patients of both sexes were included from October 2020 to July 2022 who were aged ≥18 years and had established T2DM with HbAc1 &lt;6.9%, hemodynamically stable HF (I-III NYNA functional classes), and written consent to participate in the study. According to these criteria, we prospectively enrolled 417 patients with T2DM and HF. The eligible patients were treated with the recommended guided HF therapy according to their HF phenotypes, including the consumption of SGLT2 inhibitor dapagliflozin at a dose of 10 mg OD orally, along with standard therapy of HF. Anthropometry, clinical data, echocardiography / Doppler examinations, and measurements of biomarkers were performed at the baseline and over a 6-month interval of SGLT2 inhibitor administration.

Results
Over a 6-month period after the initial prescription of SGLT2 inhibitor dapagliflozin, the levels of adropin in the entire group demonstrated a significant increase of up to 26.6% (from 2.37 [25–75% IQR = 1.91–2.75] ng/mL to 3.00 [25−75% IQR = 2.68–3.36] ng/mL, p = 0.042). In the female subgroup, the increase in the circulating levels of adropin was sufficiently higher (Δ% = 35.6%, from 2.69 [25–75% IQR = 2.31–2.99] ng/mL to 3.65 [25–75% IQR = 3.40–3.89] ng/mL, p = 0.010)when compared with those of the male subgroup (Δ% = 22.7%, from 2.11 [25–75% IQR = 1.90–2.37] ng/mL to 2.60 [25–75% IQR = 2.07–3.21] ng/mL, p = 0.161). A multivariate linear regression analysis of the entire group showed that the relative changes (Δ) in the left ventricular (LV) ejection fraction (LVEF), left atrial volume index (LAVI), and E/e` were significantly associated with increased adropin levels. In the female subgroup, but not in the male subgroup, ΔLVEF (p = 0.046), ΔLAVI (p = 0.001), and ΔE/e` (p = 0.001) were independent predictive values for adropin changes.

Conclusion
the levels of adropin seem to be a predictor for the favorable modification of hemodynamic performances during SGLT2 inhibition, independent of N-terminal brain natriuretic pro-peptide levels.
Oral anticoagulation in heart failure complicated by atrial fibrillation: a nationwide routine data study
Authors: Pudasaini S , Jeschke E , Baberg H T , Levenson B , Malzahn J , Mansky T , Michels G , Gunster C , Mockel M 
Published: November 2023

Abstract

Background/Introduction
Heart failure (HF) is frequently complicated by atrial fibrillation (AF). The co-occurrence of both conditions worsens the overall patient prognosis (1). To reduce the risk of thromboembolic complications, current guidelines highly recommend an oral anticoagulant (OAC) therapy in the majority of patients affected (2).

Purpose
Aim of this study was to evaluate whether a permanent OAC therapy in patients with HF and AF leads to favourable outcomes. Additional benefits of new oral anticoagulants (NOACs), compared to vitamin K antagonists (VKA), were further assessed.

Methods
Anonymous routine data of patients who were medically insured at the largest German health insurance provider and had a claims record for hospitalisation with the main diagnosis of HF and AF (2017-2019) were included. Admission due to HF in the previous year, incomplete medication data within 90 days after hospital stay as well as the diagnoses of congenital anomaly, transplantation, asthma, and age under 30 years were exclusion criteria. The endpoints of mortality and readmission rate for all-cause and stroke/intracranial bleeding (ICB) 91-365 days after the index hospitalisation were analysed. For this, information about the medications was taken from the pharmacy database. Kaplan-Meier survival curves and multivariable Cox regression models were used to evaluate the impact of medication on outcome. Adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs) were calculated. Patient age, sex, and comorbidities were evaluated as independent factors, including all variables of the CHA2DS2-VASc score.

Results
We included n = 180,316 cases (see figure 1). The median age was 81 years (interquartile range of 76-86) with 55.6% of the patients being female. 96.81% had a CHA2DS2-VASc score of ≥ 2. We found OAC prescription in 80.6% (VKA: 21.7%; direct factor Xa inhibitors (FXaI): 60.0%; direct thrombin inhibitors (DTI): 3.4%). In 8,087 cases, more than one OAC was prescribed. The mortality rate was 19.1%, readmission rate was 29.9% and stroke/ICB occurred in 1.9% during the observed time span. As presented in figure 2, the risk of death was lower with any OAC (HR 0.77, 95% CI 0.75-0.79) but without significant differences in OAC type (VKA: HR 0.73, 95% CI 0.71-0.76; FXaI: HR 0.77, 95% CI 0.75-0.78; DTI: HR 0.71, 95% CI 0.66-0.77). The total readmission rate (HR 0.97, 95% CI 0.94-0.99) and readmission for stroke/ICB (HR 0.71, 95% CI 0.65-0.77) was likewise lower with OAC use.

Conclusion(s)
Routine data confirm the beneficial outcome of OAC therapy in patients with HF complicated by AF regarding mortality and readmission for all-cause as well as for stroke/ICB. No additional benefits were visible with the use of NOACs.Figure 1.Patient selection criteria.Figure 2.Kaplan-Meier survival (OAC).
Sex differences for the efficacy of sodium-glucose cotransporter 2 inhibitors on cardiorenal outcomes: a systematic review and meta-analysis
Authors: Yamashita I , Fujisaki T , Romeo F J , Fujisue K , Sueta D , Usuku H , Yamamoto E , Tsujita K 
Published: November 2023

Abstract

Background
It is unclear if sex differences affect the efficacy of sodium-glucose cotransporter 2 (SGLT2) inhibitors to improve cardiorenal outcomes in patients with increased risks of cardiovascular diseases.

Methods
A systematic review was performed by searching PubMed, Cochran Central, and Embase through February 2023 for randomized controlled trials (RCTs) of SGLT2 inhibitors that were performed in adults and large (≥500 participants per group). Hazard ratios (HRs) and relative risk estimates in subgroups stratified by sex were extracted from each study and were pooled using a random-effects meta-analysis. The primary outcome was a composite of cardiovascular death, myocardial infarction, or stroke. The secondary outcomes were heart failure exacerbation, adverse renal outcomes, and a composite outcome of cardiovascular death or heart failure exacerbation.

Results
This study included 10 RCTs. SGLT2 inhibitors were associated with decreased risks of the primary outcome (Female and male in total: HR, 0.80; 95% CI, 0.67-0.96, Female: HR, 0.71; 95% CI, 0.51-0.98, Male: HR, 0.90; 95% CI, 0.83-0.97). SGLT2 inhibitors were associated with decreased risks of heart failure exacerbation (Female: HR, 0.80; 95% CI, 0.69-0.94, Male: HR, 0.78; 95% CI, 0.69-0.87), adverse renal outcomes (Female: HR, 0.65; 95% CI, 0.48-0.88, Male: HR, 0.58; 95% CI, 0.46-0.72), and a composite outcome of cardiovascular death or heart failure exacerbation (Female: HR, 0.75; 95% CI, 0.67-0.84, Male: HR, 0.78; 95% CI, 0.72-0.85). There were no significant subgroup differences by sex for all outcomes (p&gt;0.05).

Conclusions
SGLT2 inhibitor was associated with decreased risks of cardiorenal outcomes similarly in both sexes.
Two haplotype-resolved genomes reveal important flower traits in bigleaf hydrangea (Hydrangea macrophylla) and insights into Asterid evolution
Authors: Wu Xingbo , Simpson Sheron A , Youngblood Ramey C , Liu Xiaofen F , Scheffler Brian E , Rinehart Timothy A , Alexander Lisa W , Hulse-Kemp Amanda M 
Published: November 2023

Abstract
The Hydrangea genus belongs to the Hydrangeaceae family, in the Cornales order of flowering plants, which early diverged among the Asterids, and includes several species that are commonly used ornamental plants. Of them, Hydrangea macrophylla is one of the most valuable species in the nursery trade, yet few genomic resources are available for this crop or closely related Asterid species. Two high-quality haplotype-resolved reference genomes of hydrangea cultivars ‘Veitchii’ and ‘Endless Summer’ [highest quality at 2.22 gigabase pairs (Gb), 396 contigs, N50 22.8 megabase pairs (Mb)] were assembled and scaffolded into the expected 18 pseudochromosomes. Utilizing the newly developed high-quality reference genomes along with high-quality genomes of other related flowering plants, nuclear data were found to support a single divergence point in the Asterids clade where both the Cornales and Ericales diverged from the euasterids. Genetic mapping with an F1 hybrid population demonstrated the power of linkage mapping combined with the new genomic resources to identify the gene for inflorescence shape, CYP78A5 located on chromosome 4, and a novel gene, BAM3 located on chromosome 17, for causing double flower. Resources developed in this study will not only help to accelerate hydrangea genetic improvement but also contribute to understanding the largest group of flowering plants, the Asterids.
Control Estimates for 0th-Order Pseudodifferential Operators
Authors: Christianson Hans , Wang Jian , Wang Ruoyu P T 
Published: November 2023

Abstract
We introduce the control conditions for 0th-order pseudodifferential operators $\textbf{P}$ whose real parts satisfy the Morse–Smale dynamical condition. We obtain microlocal control estimates under the control conditions. As a result, we show that there are no singular profiles in the solution to the evolution equation $(i\partial _{t}-\textbf{P})u=f$ when $\textbf{P}$ has a damping term that satisfies the control condition and $f\in C^{\infty }$. This is motivated by the study of a microlocal model for the damped internal waves.