bluuebunny/crossref_metadata_2025_split huggingface dataset:
Etiology and predictors of heart failure in pregnancy. Newer Insights from the M-PAC registry
Authors: Anne Princy S , Justin Paul G , Anju Surendran S , Shoba S , Rani P R , Premakumari E , Meena T S , Thamizhselvi N , Suganthi S , Anandhi A 
Published: November 2023

Abstract

Background
Women with heart disease undergoing pregnancy is on the increase, along with an increasing cardiac contribution to maternal mortality.

Aim
To identify the proposition of pregnant women with heart disease, who develop heart failure as a complication and to identify the predictors of heart failure in pregnancy

Methods
The Madras medical college Pregnancy And Cardiac (M-PAC) registry (1) is a single-centre prospective observational registry conducted at a tertiary care public hospital in Tamil Nadu, India from July 2016 to December 2019. Patient with new or worsening heart failure during pregnancy and up to 1 week post-delivery were included in the present analysis. When heart failure was the presenting symptom, it was considered as the primary event and when patient presented with failure symptoms secondary to another inciting event, heart failure was considered as secondary event. This cohort of patient were evaluated for the aetiology, predictors and outcome of heart failure and were placed on extended follow up. The accuracy of mWHO and CARPREG I score to predict heart failure were assessed.

Results
1005 women with 1029 pregnancies were enrolled. Heart failure was observed in 127 (%) pregnancies, in 103 as primary event and in 24 as a secondary event. The common aetiologies of heart failure include rheumatic valvar heart diseases (n=45), peripartum cardiomyopathy (n=45) and congenital heart diseases (n=18). The univariable predictors of heart failure include, NYHA class at first visit, mWHO class of disease, first diagnosis of heart disease, during current pregnancy, pulmonary hypertension, left ventricular ejection fraction ≤ 45%, significant mitral stenosis, mechanical prosthetic heart valve and history of prior cardiac events. However, when peripartum cardiomyopathy was excluded from the analysis, current pregnancy diagnosis was no longer a predictor. Multivariable predictors of heart failure are shown in Figure-1. CARPREG-1 score was marginally more effective than modified World Health Organisation (mWHO) score (C-statistic of 0.820 vs 0.802) in predicting heart failure (Figure-2). Maternal death was 15.7% (20/127).
Caesarean delivery was more common in patients with heart failure (53/119; 44.5%; vs 318/838; 38%) Patients with heart failure had significantly higher proportion of composite adverse fetal outcome (46.5% vs 31.9%, P&lt;0.001), preterm birth (9.2% vs 4.5%, P=0.029) and low birth weight (41.2% vs 26%, P &lt;0.001)

Conclusion
Heart failure is the commonest complication of pregnant women with heart disease. Mortality is very high in patients presenting with heart failure. Modified WHO classification and CARPREG 1 score have moderate accuracy to predict heart failure in pregnancy.Fig-1: Predictors of Heart FailueFig-2: Prediction by CARPREG-1 and mWHO
Clinical outcomes and risk factors associated with drug-coated balloon treatment for femoropopliteal artery disease in patients on maintenance hemodialysis
Authors: Ito R , Oshima S , Kakuno M , Sakakibara T , Murohara T 
Published: November 2023

Abstract

Background
Hemodialysis (HD) patients, who are at high risk for atherosclerosis including peripheral artery disease, are associated with poor clinical outcomes after endovascular therapy. Although recent clinical trials have reported favorable outcomes after drug-coated balloon (DCB) treatment for femoropopliteal lesions, its usefulness and risk factors in HD patients have not been well elucidated.

Purpose
This study aimed to investigate clinical outcomes and the associated risk factors after DCB treatment in HD patients with femoropopliteal lesions.

Methods
This study included 140 HD patients with their 185 femoropopliteal lesions that underwent DCB treatment between September 2018 and January 2022. Non-HD patients and cases of acute limb ischemia were excluded. The endpoints were 1-year freedom from restenosis and clinically driven target lesion revascularization (CD-TLR). The risk factors were also evaluated.

Result
Duration of maintenance hemodialysis in all patients was 8.6 years. Mean lesion length was 11.0±6.9 cm, and rates of chronic total occlusion and severe calcification were 17.3% and 45.4%, respectively. Types of DCB were IN.PACT Admiral (22.9%), Lutonix (50.8%) and Ranger (24.3%). Bail-out stenting was performed in 1.1% of all lesions. The Kaplan-Meier estimate of freedom from restenosis and CD-TLR were 63.8% and 71.3% at 12 months, respectively. The freedom rates from CD-TLR after high-dose and low-dose DCB therapy were 79.4% and 66.4%, respectively (p=0.095). Risk factors independently associated with 1-year CD-TLR were diabetes [hazard ratio (HR) 2.30, 95% confidence interval (CI) 1.03-5.15, p=0.043], chronic limb-threatening ischemia (HR 1.93, 95%CI 1.05-3.53, p=0.035) and sever calcification (HR 2.42, 95%CI 1.39-4.21, p=0.0019). When patients were divided into groups according to number of these three risk factors, the rates of freedom from CD-TLR at 12 months were 100%, 94.8%, 76.7% and 30.3% among groups with no risk factor, any 1 risk factor, any 2 risk factors and all risk factors, respectively (p&lt;0.0001).

Conclusion
The 1-year clinical outcomes after DCB treatment in HD patients with femoropopliteal lesions were unsatisfactory. Independent risk factors for 1-year CD-TLR were diabetes, chronic limb-threatening ischemia and severe calcification.
The impacts of the initiation of hemodialysis for patients with newly diagnosed end-stage renal disease and normal left ventricular systolic function
Authors: Fu Y , Sung S H 
Published: November 2023

Abstract

Background
Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular disease, left ventricular dysfunction, and subsequent morbidity and mortality. How the renal replacement therapy would affect the myocardial function and the clinical outcomes remains elucidated.

Methods
A total of 60 patients with newly diagnosed ESRD and then received hemodialysis were enrolled. The participants would undergo echocardiographic studies before and at 1 year after the initiation of hemodialysis. Left ventricular global longitudinal strain (GLS) was measured. Subjects with a reduced left ventricular ejection fraction (LVEF&lt;50%) were excluded. The study population were stratified according to their post-hemodialytic GLS values. Clinical outcomes, including mortality and heart failure hospitalization were evaluated.

Result
A total of 47 patients (61.7% men, age 66.6±14.5 years) were included in this study. After hemodialysis, 27 (57.4%) patients had normal GLS, while 20 (42.6%) patients had reduced GLS. The baseline characteristics were similar in each group, except that coronary artery disease (CAD) was significantly more presented in subjects with reduced GLS (p=0.047). Moreover, LV end-systolic volume (LVESV) and right ventricular systolic pressure (RVSP), were significantly higher in those with reduced GLS than the counterpart. During a mean follow-up duration, the Kaplan-Meier survival analysis showed subjects with reduced GLS were associated with higher mortality (p=0.032). The logistic regression analysis, both LV end-systolic volume (LVESV) and right ventricular systolic pressure (RVSP) were identified as independent predictors of reduced LV GLS. After adjusting for age, sex and CAD, RVSP remained a significant predictor of reduced GLS (p=0.037).

Conclusion
In patients with ESRD, the study has demonstrated the baseline RVSP was associated with post-hemodialytic GLS, which was further correlated with long-term survival. The results may suggest RVSP could potentially reflect the impaired left ventricular systolic function. These findings may contribute to better risk stratification and clinical management in this population.
Impact of kidney function, ticagrelor and genetic polymorphism on high platelet reactivity
Authors: Kim W , Rhew J Y 
Published: November 2023

Abstract

Background
High platelet reactivity (HPR) is associated with worse clinical outcomes. Patients with chronic kidney disease (CKD) respond poorly to clopidogrel. The purpose was to investigate what is major determinant on HPR in CKD patients.

Methods
A total of 219 (139 normal kidney function, 80 CKD) patients who were treated with clopidogrel or ticagrlor were assessed platelet reactivity and genetic polymorphisms. Platelet function was evaluated by the VerifyNowTM P2Y12 assay. Genes tested were ABCB1, PON1, cytochrome P450 (CYP) 2C19, CYP2C9 and P2Y12. HPR was defined as P2Y12 reaction units ≥ 230.

Results
Platelet reactivity were significantly higher in patients with CKD compared to normal kidney function (288 ± 96 vs 223 ± 69, p &lt; 0.01). But, there were no significant differences of genetic distribution between 2 groups. In patients with CKD and normal kidney function, CYP2C19 carriers had greater platelet reactivity during clopidogrel therapy but there were no differences during ticagrelor treatment regardless of CYP2C19 status (Figure). In multivariate analysis, CKD [hazard ratio (HR): 4.67 (2.27 – 9.78), p &lt; 0.01], CYP2C19 carriers [HR: 2.81 (1.36 – 5.82), p &lt; 0.01] and ticagrelor treatment [HR: 0.29 (0.18 – 0.48), p &lt; 0.01] were significantly correlated with HPR.

Conclusion
Ticagrelor treatment achieved greater platelet inhibition in patients with CKD whereas CKD and CYP2C19 genotype were significantly correlated with HPR.
People with CKD in cardiovascular trials: a neglected population? A systematic review and evidence map
Authors: Colombijn J M T , Idema D L , Bots M L , Hooft L , Verhaar M C , Vernooij R W M 
Published: November 2023

Abstract

Background
People with chronic kidney disease (CKD) have a markedly higher risk for cardiovascular disease. Systematic underrepresentation of people with CKD in cardiovascular randomised controlled trials (RCTs) limits evidence to guide cardiovascular risk management (CVRM).

Purpose
In this systematic review we aimed to identify evidence gaps regarding CVRM medication for people with CKD and evaluated the prevalence of exclusion of people with CKD from cardiovascular RCTs.

Method
We searched Clinicaltrials.gov through the Cochrane Central Register of Controlled Trials from inception until October 2021. Eligible studies were randomised controlled trials (RCTs) that investigate the efficacy of guideline-recommended CVRM medications on (cardiovascular) mortality, cardiovascular morbidity, and end-stage kidney disease in adults with a history of cardiovascular disease or one or more major risk factors for cardiovascular disease. Two reviewers independently determined the eligibility of references and extracted data. Outcomes were an overview of studies that report results for people with CKD, evidence gaps in results, and the rate of exclusion of people with CKD.

Results
We included 1180 of the 2794 eligible RCTs involving 2,158,869 participants (mean age 63±6 years, 36% female). Overall, 841 (71%) RCTs excluded (subgroups of) people with CKD based on heterogenous exclusion criteria. Since 2000, this prevalence has increased from 70% to 75%. Of included RCTs, only 157 (13%) reported results for people with CKD (again in heterogenous subgroups). The prevalence of RCTs with results for people with CKD has increased since 2000 from 10% to 23%. Nevertheless, significant evidence gaps remain for most CVRM interventions, particularly for those with an eGFR &lt;30 ml/min/1.73m2 (22 RCTs), and people who are treated with dialysis (14 RCTs) or received a kidney transplant (1 RCTs).

Conclusion(s)
The majority of cardiovascular RCTs continues to exclude (subgroups of) people with CKD and this has only increased over the years. Although more RCTs report results for people with CKD, evidence gaps for the efficacy most CVRM medications persist, particularly for those with severe CKD.Figure 1:Heat map (subgroup) analyses for MACE for people with different stages CKD. Panel A illustrates analyses for hypertension, panel B for antiplatelets and anticoagulants, panel C for cholesterol-lowering drugs, panel D for glucose-lowering drugs, and panel E for combinations of interventions.
Impact of mildly reduced kidney function on 5-year mortality in patients with STEMI treated with primary PCI
Authors: Popovic J , Milasinovic D , Mehmedbegovic Z , Jelic D , Zobenica V , Dukic D J , Radomirovic M , Klaric M , Mladenovic D J , Sarenac D , Travica L , Zejak N , Asanin M , Stankovic G 
Published: November 2023

Abstract

PURPOSE
Previous research associated renal failure (RF), as documented by estimated glomerular filtration rate (eGFR) &lt;60 ml/min/1.73m2, with increased mortality risk following acute myocardial infarction. Our aim was to assess the impact of baseline mild RF (eGFR 60-89 ml/min/1.73m2) on mortality during 5-year follow-up after ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI).

Methods
The study included 8378 STEMI patients undergoing primary PCI in the period from 2009 until 2019 for whom baseline eGFR data were available, according to the Modification of Diet in Renal Disease (MDRD) study equation. Cox regression models were created to assess the effect of different stages of renal failure on 30-day and 5-year mortality. Follow-up data were available for 8202 patients at 30 days and 5650 patients at 5 years.

Results
Renal function was impaired in 49% of patients (eGFR &lt;30 ml/min/1.73m2 in 2.5%, eGFR 30-59 ml/min/1.73m2 in 16.2% and eGFR 60-89 ml/min/1.73m2 in 30%). Patients with eGFR &lt;90 ml/min/1.73m2 had higher mortality rates at 30 days (10.0% vs. 1.7%, p&lt;0.001) and at 5 years (44.1% vs 13.5%, p&lt;0.001). Mortality increase was synchronous with the degree of renal failure at both 30 days and 5 years (Figure, panel A and B, respectively). At 30-days, patients with mild RF had higher adjusted mortality compared to patients with eGFR&gt;90 ml/min/1.73m2 (HR 1.6, CI95% 1.1-2.4, p 0.027). At 5 years, eGFR 60-89 ml/min/1.73m2 was also associated with the higher adjusted mortality (HR 1.4, CI95% 1.2-1.6, p&lt;0,001). As expected, severe (eGFR &lt;30 ml/min/1.73m2) and moderate (eGFR 30-59 ml/min/1.73m2) renal failure was associated with a higher risk of mortality (30 days: HR 4.4 and 2.6 respectively; 5 years: HR 3.7 and 2.2 respectively).

Conclusions
The risk of short- and long-term mortality after STEMI increases proportionally with the degree of baseline renal failure. Compared with patients with a normal renal function, even mild renal failure (eGFR 60-89 ml/min/1.73m2) is associated with higher mortality at both 30 days and 5 years.
The impact of pulmonary hypertension on early postoperative period after lung transplantation with particular emphasis on kidney function
Authors: Wajda-Pokrontka M , Nadziakiewicz P 
Published: November 2023

Abstract

Background
A special group of lung transplantation (LTx) recipients are patients diagnosed with pulmonary hypertension (PH) in the form of idiopathic pulmonary arterial hypertension (IPAH) or chronic lung diseases associated PH (CLD-PH). Acute left heart failure is a major complication observed in the early post-transplant period of patients with PH. To avoid post-transplant cardiac failure, the following measures may be implemented: use of intraoperative veno-arterial extracorporeal membrane oxygenation, administration of inotropic agents, a restrictive fluid management or use of continuous renal replacement therapy. Although, it remains unclear whether such a therapy affects long-term kidney function and patient survival.

Purpose
To analyze the influence of pulmonary hypertension diagnosis on early postoperative outcome including deterioration of renal function defined as the change in eGFR that occurred between baseline eGFR and the first and seventh day of observation post-LTx.

Methods
Retrospective data analysis of 79 patients undergoing lung transplantation in 2015-2018 in our institution with diagnosis of PH. Exclusion criterium was absence of 7 days observation post LTx or lack of PH diagnosis. The comparison of pre- and postoperative data was performed between IPAH (N=7) and CLD-PH (N=43) patients.

Results
We found differences in preoperative serum creatinine levels between IPAH and CLD-PH group (109,5 umol/l (70-126) vs 62,3 umol/l (49,3-73,4), respectively), p&lt;0.05. The greatest decline of eGFR in the early postoperative period was demonstrated on day 7 in both groups (ΔeGFR=42,2±6,7 for CLD-PH group and 56,5±9,8 for IPAH group). Patients did not differ according to age, sex and BMI values. In IPAH group operation tend to last longer (657,9±78,2 min vs 539,6±111,6 min, p&lt;0.05), all of them were performed with the use of cardiopulmonary bypass. All patients from IPAH group and 95,6% from CLD-PH group received inotropic support during LT procedure and early postoperative days. Duration of mechanical ventilation was statistically shorter among CLD-PH patients (2,9 days (0,8-1,4) vs 6,1 days (3,3-39), p&lt;0.001).

Conclusion
It seems to be probable that pulmonary hypertension could be significant risk factor of kidney deterioration after lung transplantation. Identification of factors modifying renal insufficiency development in lung transplant recipients needs further investigations.
Postural orthostatic tachycardia syndrome (POTS) and other autonomic dysfunction following COVID-19 infection: incidence, characteristic and associating factors
Authors: Tanking C , Lakkananurak C , Srisakvarakul C , Panda S , Jitpreeda A , Leethananirawit N , Punprame P , Threechod K , Sukitpunyaroj D 
Published: November 2023

Abstract

Background
Long-COVID syndrome has become a new health concern. Many major clinical centers worldwide have experienced more patients with symptoms suggestive of autonomic dysfunction especially Postural Orthostatic Tachycardia syndrome (POTS). These patients were previously diagnosed with COVID19. However, there is lack of incidence and associating factors in Asian population.

Objective
This study investigated the incidence, associating factors and clinical features in patients with new-onset symptoms suggesting POTS or other autonomic disorders following COVID-19 infection.

Methods
We conducted a retro-prospective study to evaluate patients from COVID-19 outpatient clinic who have symptoms suggestive of POTs or other autonomic dysfunctions. These symptoms must last at least three months after PCR proven COVID 19 infections. Exclusion criteria were age &lt; 18 years old, pregnancy and pre COVID-19 infection symptoms. Patients with symptoms severity score greater than two were assessed with blood tests, 24-hour Holter, 24-hour ambulatory blood pressure, echocardiogram and underwent head-up tilt table (HUTT).

Results
793 patients were interviewed at a mean of 146± 37 days after COVID-19 infection. Majority of patients are middle-aged female. 15 patients with symptoms severity score &gt;2 were investigated. Out of those 15 patients, 12 have positive HUTT (1 demonstrating POTS, 10 neuro cardiogenic syncope, and 1 orthostatic hypotension). Among those positive HUTT patients, C-reactive protein (CRP) is significantly higher (OR 1.01; p-value 0.041). Fatigue and orthostatic intolerance are the two most complaint symptoms. All patients with positive HUTT have non dipping pattern on 24-hour ambulatory BP monitoring.

Conclusions
This study demonstrates incidence of 1.5% (12 out of 793) autonomic dysfunction and 0.1% POTS (1 out of 793) among post COVID-19 outpatient cases . Associating factor includes high CRP during infection. Most complaint symptoms are fatigue and orthostatic intolerance.Patient flow diagramType and severity of symptoms
Angio-IMR identifies microvascular cardiac allograft vasculopathy in heart transplant recipients
Authors: Weiss K J , Hohendanner F , Diedrichs F , Reiber J H C , Castillo Tovar J , Falk V , Schoenrath F , Stawowy P , Just I A 
Published: November 2023

Abstract

Background/Introduction
Microvascular cardiac allograft vasculopathy (mCAV) is a prognostic factor for long-term survival after heart transplantation, which can be assessed by endomyocardial biopsies (EMBs). (1) Routine diagnostic follow-up consists of coronary angiography and an EMB in selected patients. Non-biopsy methods for diagnosing microvascular dysfunction (MVD) have increasingly been proven valuable in these patients and avoid the inherent risk of repeated EMB. (2) Recently, an angiography-derived index of microcirculatory resistance (angio-IMR) has been reported as a novel, post-processing pressure-wire-free tool to assess coronary microvascular dysfunction in coronary angiograms. (3) Its usefulness in heart transplant recipients remains unknown.

Purpose
This analysis aimed to compare the assessment of mCAV with angio-IMR and EMB findings.

Methods
We retrospectively evaluated coronary angiograms of 27 asymptomatic heart transplant recipients (11% female, mean age 46.6 years ± 12.3 years) who underwent simultaneous coronary angiography and right ventricular biopsy within post-transplant aftercare at our institution. We derived angio-IMR from the left anterior descending coronary artery (LAD) using two views with at least a 30° angle to each other and invasively measured mean aortic pressure (MAP). Histopathologic mCAV was routinely evaluated by light microscopy (x200) and defined as no mCAV, obstructive or non-obstructive mCAV. The correlation between time after heart transplantation and angio-IMR was using Pearson's Correlation Coefficient and angio-IMR was compared between mCAV groups using Kruskal–Wallis test, assuming statistical significance at p&lt;0.05. (1)

Results
Three patients (11%) showed obstructive, 13 (48%) non-obstructive, and 11 (41%) showed no mCAV. The mean time after heart transplantation was 1683 days ± 1140 days. The mean angio-IMR was 38.6 mmHg*s ± 10.2 mmHg*s, with a positive correlation between angio-IMR and time since heart transplantation (r[25] = 0.695, p &lt; 0.001, figure A [green = no; yellow = non-obstructive and red = obstructive mCav]). Compared to patients without mCAV (29.7 mmHg*s ± 5.3 mmHg*s), angio-IMR was increased in patients with non-obstructive (42.4 mmHg*s ± 6.9 mmHg*s, p = 0.002) and obstructive mCAV (54.6 mmHg*s ± 8.5 mmhg*s, p = 0.002, figure B).

Conclusion
Angio-IMR correlates with histological mCAV and time since transplantation in heart transplant recipients. This value could potentially help in the clinical routine management of these patients and avoid the inherent risk of repeated EMB.Figure AFigure B