bluuebunny/crossref_metadata_2025_split huggingface dataset:
The association between left ventricular ejection fraction and long-term survival: a large hospital-based cohort study in taiwan
Authors: Chang H C , Sung S H 
Published: November 2023

Abstract

Background
Left ventricular ejection fraction (LVEF) is the most commonly used metric for quantifying left ventricular function. A U-shaped relationship between LVEF and long-term survival with a nadir between 60-70% has been reported in the western, regardless of age, sex, or prevalent heart failure. However, the distribution of mortality risk across the spectrum of LVEF among Asian population remains unclear.

Purpose
We aim to investigate the distribution of mortality risk across the spectrum of LVEF among Asian population, as well as among different subgroups.

Methods
In this large hospital-based cohort study, consecutive participants who underwent echocardiography (2002-2021) in a tertiary medical center in Taiwan were included. LVEF was measured by echocardiography using biplane Simpson’s method. All LVEFs were categorized into intervals of 5% from &lt;20% to ≥70%. The National Death Registry was linked to identify mortality and causes of death. Cox proportional hazards regression was used for analyses with adjustment for age, sex, body mass index, and comorbidities.

Results
A total of 142,834 participants (age 60.6 ± 18.4, men 50.5%) were included. During a mean follow-up of 58.1 ± 47.1 months, 17,317 subjects (12.1%) died. Overall, adjusted hazard ratios (HR) for all-cause mortality showed a U-shaped relationship between LVEF and long-term survival with a nadir of risk at LVEF of 60-70%. Compared with the reference group (LVEF: 60-65%), subjects with LVEF&gt; 70% had a HR of 1.21 (95% confidence interval [CI]: 1.12-1.30) and those with LVEF of 50-55% had a HR of 1.28 (95% CI: 1.22-1.35). (Figure) Similar results with a nadir at 60-70% could also be observed when stratified by the age of 65, sex, comorbidities of hypertension, or diabetes.

Conclusions
A U-shaped relationship between LVEF and long-term survival with a nadir at LVEF of 60-70% can also be observed in the Asian population. This result may support the use of LVEF&gt; 70% to define supranormal LVEF in Asian subjects.Figure
Contemporary insights into the epidemiology, impact and treatment of secondary tricuspid regurgitation across the heart failure spectrum
Authors: Heitzinger G , Pavo N , Winter M P , Spinka G , Dannenberg V , Prausmueller S , Dona C , Halavina K , Mascherbauer K , Nitsche C , Strunk G , Hengstenberg C , Huelsmann M , Bartko P E , Goliasch G 
Published: November 2023

Abstract

Background
Tricuspid regurgitation secondary to heart failure (sTR) is common with considerable impact on survival and hospitalization rates. Currently, insights into epidemiology, impact, and treatment of sTR across the entire heart failure (HF) spectrum are lacking yet are necessary for informed health care decision-making.

Purpose
To investigate (i) the demographic aspects of sTR overall and according to HF subtype, (ii) the association of sTR with mortality compared to expected survival in the age and sex matched community (iii) differences in subgroups, to identify patients at increased risk of mortality and (iv) to assess treatment demand and utilization for sTR in a unique setting with a population-wide health-care plan and state-of-the-art medical facilities.

Methods
This population-based study included individual data from 13469 patients with HF and sTR over a 10-year period. Primary outcome measure was long-term mortality.

Results
Overall, heart failure with preserved ejection fraction (HFpEF) was the most frequent (57%, n = 7733) HF subtype and the burden of comorbidities was high. Severe sTR was present in 1514 patients (11%), most common among patients with reduced EF (HFrEF) (20%, n = 496). Mortality of patients with sTR was higher than expected survival of sex- and age-matched community and independent of HF subtype (moderate sTR: Hazard ratio [HR] 6.32; 95% Confidence Interval [CI] 5.88-6.80, P&lt;0.00, severe sTR: HR 9.04; 95% CI 8.27-9.87, P&lt;0.001). In comparison to HF and no/mild sTR patients, mortality increased for moderate sTR (HR 1.58, 95%CI 1.48-1.69, P&lt;0.001) and for severe sTR (HR 2.19, 95%CI 2.01-2.38, P&lt;0.001). Survival is presented in Figure 1. This effect prevailed after multivariate adjustment and was similar across all HF subtypes (Figure 2). In subgroup analysis severe sTR mortality-risk was more pronounced in younger patients (&lt;70a). Moderate and severe sTR were rarely treated surgically or percutaneously (3%, n = 147), despite availability of state-of-the-art facilities and universal health care.

Conclusion
sTR is frequent, increasing with age and associated with excess mortality independent of left ventricular ejection fraction. Nevertheless, sTR is rarely treated surgically or percutaneously. With the projected increase in HF prevalence and population ageing the data suggest a major burden for health-care systems, that needs to be adequately addressed. Low-risk transcatheter treatment options may provide a suitable alternative.Figure 1Figure 2
Comparative effectiveness of GDMT in the prevention of HF morbidity and death among patients with HFrEF in a U.S. database
Authors: Coyle C R , Ru B , Gaggin H K , Mcmullen C J , Stevenson A S , Ai L , Bash L D , Ambrosy A P 
Published: November 2023

Abstract

Background
The incremental benefit of comprehensive over conventional guideline-directed medical therapy (GDMT) in real-world setting has not been well demonstrated in patients with heart failure with reduced ejection fraction (HFrEF). This study aims to compare patients on GDMT, including first-line therapy from the most recent US guidelines on the prevention of worsening heart failure events (WHFE) and all-cause death.

Methods
This study used Optum’s de-identified Clinformatics® Data Mart Database to identify patients who have diagnosed HFrEF and prescription fills for components of GDMT ("Conventional GDMT" i.e., ACEi or ARB, and beta-blocker) and first-line therapy from the most recent US guidelines ("2022 GDMT:" i.e., ARNi, MRA, beta-blocker, SGLT2i) between Jan2020 and Mar2022. This study characterized patients on both types of GDMT and compared the residual risk of WHF events (HF hospitalizations or receipt of IV diuresis) and death.

Results
The Conventional and 2022 GDMT cohorts included 26,517 and 2,775 patients, respectively. The Conventional GDMT cohort was older (74 vs. 68 years), more often female (41% vs. 33%) and white (67% vs. 60%). In general, they had more comorbidities, but a smaller proportion had diabetes mellitus (53% vs. 67%) and PVD (37% vs. 58%). The unadjusted Kaplan Meier curves show time from GDMT initiation to WHFE, or all-cause death was significantly (p&lt;0.01) faster in the Conventional GDMT cohort compared to 2022 GDMT cohort. The unadjusted HR for experiencing a WHFE or all-cause death after starting GDMT was 0.88 (p&lt;0.01) and 0.48 (p&lt;0.001), comparing the 2022 GDMT cohort to Conventional GDMT cohort. These results were attenuated (WHFE: HR: 0.90, p = 0.02; all-cause death: HR: 0.66, p&lt;0.001) after adjusting for demographic characteristics and comorbidities.

Conclusion
In this sample, patients on the most recent GDMT (2022 GDMT cohort) had better outcomes than those on conventional GDMT. However, the improvement was less noticeable in the prevention of WHFE. Results highlight the ongoing risk of HF-related morbidity and all-cause mortality among patients with HFrEF, despite the use of first-line therapy and underscores the need for therapeutics beyond optimized GDMT to lower the risk in this high-risk population.
The global burden of heart failure: a systematic analysis for the Global Burden of Disease Study 2021
Authors: Roth G A , Dorsey H , Decleene N , Razo C , Stark B , Johnson C 
Published: November 2023

Abstract

Background
Heart failure is a common reason for hospitalization and is associated with high health care costs and high symptom burden. Updated estimates of global and regional prevalence and underlying causes of HF may be helpful in guiding health policy and investment priorities.

Purpose
To provide comparable and consistent estimates of heart failure burden as part of the Global Burden of Disease (GBD) 2021.

Methods
We identified all available data on prevalence, incidence, and mortality for heart failure in the general population. Sources included published scientific literature, administrative records from national health systems, and vital registration data. We generated estimates of heart failure prevalence using DisMod-MR 2.1, a geospatial modelling software program. We then estimated the proportion of prevalent heart failure due to each of 27 underlying aetiologies to produce age-, sex-, location-, year-, and aetiology-specific estimates of heart failure burden.

Results
In 2021, there were 56.5 million (95% Uncertainty Interval (UI): 49.7 million to 63.7 million) prevalent cases of heart failure globally. There were 27.3 million (24.0 to 30.8) prevalent cases in females and 29.2 million (25.6 to 33.0) cases among males. Age-standardized prevalence increased from 647.9 (556.3 to 739.9) per 100,000 in 1990 to 682.7 (602.8 to 766.8) per 100,000 in 2021. The North Africa and Middle East super region had the highest age-standardized prevalence in 2021 (780.5 per 100,000 (658.7 to 907.6)) and South Asia had the lowest age-standardized prevalence (600.1 per 100,000 (526.5 to 671.4)). In 2021, Ischaemic heart disease, hypertensive heart disease, and other cardiomyopathy were responsible for the majority of prevalent heart failure cases worldwide, at 33.8% (28.4% to 38.3%), 22.6% (19.0% to 27.1%), and 8.2% (7.0% to 9.6%), respectively. Country specific estimates for both sexes combined in 2021 are shown in the map.

Conclusion
Heart failure is a highly prevalent condition, particularly in older age groups. As populations age and risk profiles change around the world, knowledge of the global epidemiology of heart failure will be critical in preventing or treating its underlying aetiologies in order to decrease its overall burden.Heart failure prevalence, 2021
Impact of patient characteristics on heart failure and cardiomyopathy onset related to pregnancy from 1997 to 2019. Swedish nationwide register-based study
Authors: Basic C , Toska T , Schaufelberger M , Svanevik T , Rosengren A , Thunstrom E 
Published: November 2023

Abstract

Background
The aetiology of heart failure (HF) in young patients is heterogenic. Cardiomyopathies are common causes in young patients, that often unmask in situations of higher physical demands, as pregnancy or delivery, presenting with HF signs and symptoms. Peripartum cardiomyopathy (PPCM) is one form associated with delivery. However, even other, such as dilated or hypertrophic cardiomyopathy may present during pregnancy. Despite major advances in care, there is still a lack of knowledge about factors that trigger heart failure onset during pregnancy and delivery.

Aim
To evaluate the association of baseline characteristics for HF and cardiomyopathy (CM) onset related to delivery, and investigate incidence rate for HF and cardiomyopathies related to delivery over time.

Method
All women 18 to 50 years registered in the National Patient Register (NPR) from 1st January 1997 to 31st December 2019 were included. Time of delivery was obtained from the Swedish Medical Birth Register (MBR), time of death from the Cause of Death Register. Women with HF, CM and peripartum cardiomyopathy (PPCM) were identified from the NPR with international classification codes for disease ICD-10: I50, I42, I43 and 090.3, used for the first time 90 days prior or 180 days after delivery, and other comorbidities. Patients were compared with five controls without HF or CM from the Total Population Register matched by age, year of delivery, and county. Linear regression was used to test trend changes in use of ICD codes. The impact of baseline characteristics for onset av HF, CM and PPCM in patient compared to controls is presented as odds ratio (OR). Body mass index (BMI) was registered at the beginning of pregnancy.

Results
Between 1997 and 2019 we identified 2 347 723 deliveries, and 694 women with HF, CM or PPCM, median age 33 (29; 37) years and 3 465 controls. Out of those 493 (71%) had HF, 201 (29%) had any CM and 195 (28.1%) had PPCM. Over time the incidence rate of all conditions increased significantly, se Figure 1. Median BMI at the start of pregnancy increased significantly over time in patients with HF from 22 (20;28) to 27 (23;32), beta 0.1323 (p = 0.0216). Compared to controls patients with congenital heart disease OR at 18.32 (10.04-33.41), valve disease OR at 22.65 (8.55-60.03), arrythmia OR at 7.45 (4.06-13.67), hypertension OR at 7.89 (4.26-14.63), diabetes mellitus type II OR at 8.07 (2.63-24.74) and gestational diabetes OR at 3.93 (2.54-6.07) (all p&lt;0.001) to for HF, CM or PPCM onset related to delivery, also BMI &gt;22,5 at the beginning of pregnancy, lower education level and income, se Figure 2.

Conclusion
Over 22 years we observed a significant increase in the incidence rate of HF and CM related to delivery. BMI already &gt;22,5 was associated with higher risk for HF or any CM onset in relation to delivery.
Prediction of incident heart failure through deep learning-based analysis of 1-lead ECGs
Authors: Neyazi M , Bremer J , Knorr M , Brederecke J , Ojeda F , Blankenberg S , Schnabel R B 
Published: November 2023

Abstract

Background/Introduction
Identification of individuals at risk for heart failure (HF) can lead to early intervention. However, large scale screening for incident HF in the general population is insufficient, partly due to the limited capacities in health care systems and number of health care specialists. One-lead ECGs, e.g. from wearables capable of deriving this biomarker, are becoming more popular in the population. This holds the potential to identify individuals at risk who could benefit from a referral to a HF specialist.

Purpose
We examined the ability to predict three-year HF incidence from 1-lead ECGs using a deep learning (DL) model that was trained on data from the UK Biobank (UKB).

Methods
The UKB was established in 2006 and contains data from 500,000 participants from the British general population. N = 100,551 1-lead ECGs from 91,898 unique participants were used for this study. This includes 57,897 3-lead resting ECGs written during ergometry exams between 2006 and 2010 (Exam 1; median age 56.7 years, 46.2% men) and at the first follow-up from 2010-2013 (Exam 2; median age 61.3 years, 49% men) and 32,828 12-lead resting ECGs which were acquired between 2014 and 2020 (Exam 3; median age 63.5 years, 48.4% men). Lead I was extracted from the ECGs for all analyses. A 1D-Convolutional Neural Network was used for prediction of the 3-year risk of incident HF. A comparison with the CHARGE-AF score was performed using a nested 6-fold cross-validation scheme. The models were evaluated using the Area Under the Curve (AUC).

Results
In all three exams, the DL model was able to reliably detect 3-year incident HF (AUC; Exam 1: 0.738, Exam 2: 0.822, Exam 3: 0.738) while the CHARGE-AF score provided slightly better predictions at Exam 1 and Exam 3 (AUC 0.766, 0.748), but lower results in Exam 2 (AUC 0.736). Combining both models led to increased discriminatory properties across all exams (AUC; Exam 1: 0.812, Exam 2: 0.832, Exam 3: 0.788).

Conclusion
The derived DL model shows high discriminatory ability in the prediction of incident HF from 1-lead ECGs. The predictive ability can be further increased when combined with simple clinical variables from the CHARGE-AF score. This study represents another step towards the application of DL-based analysis of the ECG to advance health care.
Serum iron dynamics and mortality in patients with heart failure: A population-based cohort study
Authors: Ren Q W , Tsang T W , Chan H C , Yiu K H 
Published: November 2023

Abstract

Background
Iron deficiency (ID) is common among patients with heart failure (HF). Little is known about the impact of serum iron dynamics on mortality in HF.

Methods
Using a previously validated territory-wide clinical information registry, all eligible patients with HF (N = 112, 938) from 1996 to 2020 were enrolled. The index date was defined as the date of which HF was first diagnosed. Iron, ferritin and transferrin saturation (TSAT) values were retrieved both at baseline (1 year before index date) and during follow-up period (1 year after the index date until study end). The association between iron levels and risk of mortality was evaluated both on a continuous scale using restricted cubic spline curves and by categories using Cox proportional hazards regression model with competing risk as appropriate. Cut-points of iron were determined by the optimal equal-HR method. Inverse probability of treatment weighting (IPTW) was used to balance the covariates among iron groups. Changes in iron from baseline to follow-up were expressed by Sankey curve. The outcome was all-cause mortality.

Results
The mean age of the cohort was 73.0±12.2 years and 51,340 (45.5%) were male. The association between iron levels and the risk of all-cause mortality was a U-shaped curve. The risk of all-cause mortality reached a nadir between iron levels of 8.2 umol/L and 25.8 umol/L and was lowest at 13.5 umol/L. Accordingly, iron levels were divided into 3 groups: low iron (≤8.2 umol/L), midrange (8.2-25.8 umol/L), high iron (&gt;25.8 umol/L). Compared to those who remained at midrange iron level during follow-up, risk of mortality was higher in those with persistently low and persistently high iron levels (HR 1.32, 95%CI 1.27 to 1.38; HR 2.24, 95%CI 1.74 to 2.89, respectively). Further, changes in iron levels from low to high (HR 1.41, 95%CI 1.24 to 1.61); mid to low (HR 1.15, 95%CI 1.10 to 1.20), mid to high (HR 1.29, 95%CI 1.13 to 1.49); high to low (HR 1.36, 95%CI 1.15-1.60), or high to mid (HR 1.18, 95%CI 1.00-1.38) also demonstrated higher risks of mortality. (Table 1)

Conclusion
The prevalence of low iron status is high among patients with HF. Both low or high iron levels at baseline, and changes to the lower or higher ends of the iron level spectrum during follow-up were associated with higher risks of all-cause mortality.cubic spline curve
NTproBNP values for diagnosis of congestive heart failure in old patients regarding kidney failure
Authors: Berthelot E , Lehova X , Bailly M T , Hamdadou R , El Hatimi S , Hrynshynshyn N , Jourdain P 
Published: November 2023

Abstract

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

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 creatinine clearance (CrCl) of patients, NT-proBNP threshold values was lower in patients with CrCl ≥40 ml/min compared to that of patients CrCl &lt;40 ml/min, 1681 and 2238 ng/L respectively. The NTproBNP threshold for ‘ruling-out’ AHF had 81% sensitivity in patient with CrCl ≥40 ml/min and 87% sensitivity in patient with CrCl &lt;40 ml/min. In patients with CrCl ≥40 ml/min compared with patient with CrCl &lt;40 ml/min, predictive positive value was 82 and 89 %, specificity was 70% and 45% and AUC was 0.81 and 0.69. The other comorbidities that statistically change NTproBNP cutpoint diagnostic value were atrial fibrillation, age and sex.

Conclusion
In old patients referred for acute dyspnea with NTproBNP dosage at admission with kidney failure, cutpoint values of 1681 and 2238 ng/L according to CrCl allow for an accurate diagnosis of AHF.
The effect of iron deficiency on RV function in acute decompensated heart failure patients
Authors: Engin K , Sinan U Y , Arslan S , Kucukoglu M S 
Published: November 2023

Abstract

Background
Iron deficiency is a major problem in heart failure (HF) patients. Although the negative impact of iron deficiency on left ventricular (LV) function is known, the effect on right ventricle function (RV) is unclear. In this study we aimed to investigate the effect of iron deficiency on RV function.

Material and Methods
A hundred patients hospitalized with acute decompensated HF (ADHF) regardless of LV ejection fraction (LVEF) were included in our study. The primary outcome was association between iron deficiency and TAPSE, RVEF, RV FAC, and RV TDI S’. The secondary outcome was impact of iron deficiency on RV free wall global longitudinal strain (GLS).

Results
The mean age of study population was 70±10 years-old and 64% were male. The prevalence of hypertension (HT), diabetes mellitus (DM), ischemic heart disease (IHD), chronic obstructive pulmonary disease (COPD) was 80%, 52%, 71%, and 18%, respectively. While the median LVEF was 35%, the proportion of patients with reduced EF (HFrEF), mildly-reduced EF (HFmrEF), and preserved EF (HFpEF) was 66%, 6% and 28%, respectively. On transthoracic echocardiography the median TAPSE was 16.4 mm, the mean FAC %37,2±7.8, the mean RV GLS %-16.4±5.1, and the mean RV TDI S’ was 10.6±2,9 cm per second. More than half of the patients (58%) had iron deficiency. There was no difference between patients with or without iron deficiency on neither demographics nor LVEF, RV FAC, RV TDI S’ and systolic pulmonary artery pressure (sPAP). The TAPSE (15.6 vs 17.2 mm, p = 0.05) and RV free wall GLS (-14.7% vs -18.2%, p = 0.005) was lower in HF patient with iron deficiency. Anemia was present in 56% of the patients and both TAPSE (15.3 vs 17.3 mm, p = 0.01) and RV GLS (-14.7% vs -18.6%, p = 0.01) were lower in patients with anemia.

Conclusion
RV dysfunction accompanying LV dysfunction adversely affects the prognosis. In patients with ADHF, iron deficiency causes subclinical RV dysfunction namely decreased RV free wall GLS before the right ventricle systolic functions parameters commonly used on echocardiography (RVEF, TAPSE, RV FAC, RV TDI S’) in daily practice deteriorate. In conclusion, screening for iron deficiency in HF patients facilitates early detection and treatment of iron deficiency which prevents RV dysfunction with iron replacement.Table 1Table 2