bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left atrial strain measurement to predict new-onset atrial fibrillation in ST-elevation myocardial infarction patients
Authors: Caunite L , Myagmarjdorj R , Galloo X , Laenens D , Stassen J , Nabeta T , Yedidya I , Meucci M C , Kuneman J H , Van Den Hoogen I J , Van Rosendael S E , Wu H W , Van Den Brand V , Ajmone Marsan N , Bax J J 
Published: November 2023

Abstract

Background/Introduction
ST-elevation myocardial infarction (STEMI) remains a healthcare burden not only through increased mortality risk, but also development of chronic cardiac pathologies like atrial fibrillation (AF). Left atrial (LA) reservoir strain is a known predictor of incident AF in the general population.

Purpose
Our aim was to explore the additional prognostic value of LA reservoir strain measured by transthoracic echocardiography (TTE) in STEMI patients for new-onset atrial fibrillation (NOAF).

Methods
Data were analyzed retrospectively from an ongoing STEMI registry. Patients with previous myocardial infarction, AF, known history of heart failure, severe valvular pathology, suboptimal image quality, AF during TTE or missing follow-up were excluded. TTE was performed within 48 hours of hospitalization. LA reservoir strain was measured in apical 4-chamber view. LA strain &lt;23% was used as cut-off value for impaired LA function as previously established. The endpoint was NOAF. Follow-up was censored at last patient visit or at 5 years.

Results
In total 1238 patients (mean age 60±12 years; 930 (75%) men) were included. After median follow-up of 22 months (IQR 12; 60) 106 (8.6%) patients developed NOAF, most events (71 (67%)) taking place within the first year after STEMI. Mean LA reservoir strain was more impaired in patients who developed NOAF as compared to those who did not (19.3 ± 8.1% versus 24.3 ± 8.8% respectively (p&lt;0.001). Clinical and echocardiographical characteristics are shown in the table. Cumulative event-free survival rates at 1, 3 and 5 years in patients with preserved versus decreased LA strain were 97%, 95% and 93% versus 91%, 89% and 83% respectively (Log-rank X2 = 21.1; p&lt;0.001; Figure). Factors significant on univariable Cox regression analysis (age, presence of chronic obstructive pulmonary disease, troponin levels, left ventricular end-diastolic diameter, interventricular septum diameter, left ventricular global longitudinal strain, LA volume index, LA reservoir strain, E/E’ ratio and right ventricular fractional area change) were included in multivariable model, where LA reservoir strain remained significantly associated with NOAF (HR 0.96 (0.93 – 0.99); p=0.015). Addition of LA strain provided incremental prognostic value over baseline clinical risk factors, traditional TTE parameters and left ventricular global longitudinal strain (X2 84.5 vs 88.8; p=0.013).

Conclusion
LA reservoir strain was associated with new-onset atrial fibrillation in STEMI patients after adjusting for relevant clinical and echocardiographic risk factors.TableFigure
Postsystolic shortening by speckle tracking echocardiography predicts cardiovascular events and death in the general population
Authors: Lindhardt N , Lindhardt N B , Lassen M C H , Skaarup K G , Johansen N D , Jensen G B , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: November 2023

Abstract

Background
Postsystolic shortening (PSS) have demonstrated to be a valuable predictor of contractile dysfunction in the myocardium. Our objective was to investigate the prognostic value of PSS, assessed by two-dimensional speckle tracking echocardiography (2DSTE), in relation to cardiovascular morbidity and mortality in a large general population study.

Methods
This prospective longitudinal study consisted of 4466 participants of the general population. The postsystolic index (PSI) was defined as follows: [(maximum strain in cardiac cycle–peak systolic strain)/(maximum strain in cardiac cycle)]×100. The endpoints were heart failure, major adverse cardiovascular events (MACEs), and all-cause mortality.

Results
During a median follow-up of 3,5 years, 148 participants (3.8 %) experienced MACE, 85 participants (2.2 %) were diagnosed with heart failure, and 192 (4.9 %) died. In unadjusted models, PSS was significantly associated with both MACE, heart failure and all-cause mortality. Following multivariable adjustments, PSS remained significantly associated with MACE (HR: 1.54; [95% CI, 1.04 – 2.3]; P=0.033) and heart failure (HR: 1.28; [95% CI, 1.11 – 1.49]; P &lt; 0.001). PSI provided incremental prognostic value in relation to MACE (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P &lt; 0.001) and heart failure (SCORE risk chart with the addition of PSI: 0.86 (0.83-0.89), P = 0.014.

Conclusions
In the general population, PSS as assessed by two-dimensional speckle tracking echocardiography independently predict the occurrence of both MACE and heart failure.Postsystolic index cubic spline curves
Left atrial strain predicts stroke recurrence and death in patients with cryptogenic stroke
Authors: Vera Sainz A , Cecconi A , Ximenez Carrillo A , Ramos C , Martinez-Vives P , Lopez Melgar B , Sanz Garcia A , Ortega G , Aguirre C , Montes A , Vivancos J , Jimenez-Borreguero L J , Alfonso F 
Published: November 2023

Abstract

Background
Left atrial strain (LAS) has been widely studied as predictor of atrial fibrillation (AF) after cryptogenic stroke (CS). However, the evidence about its prognostic role in terms of stroke recurrence and death in this setting remains scarce.

Methods
From April 2019 to April 2022, 92 consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography, including LAS was performed during admission. The primary outcome was the composite of stroke recurrence or death.

Results
Mean age was 77.5±7.7 and 58% of patient were female. After a median follow up of 28 months, the primary outcome measure occurred in 15 patients (16%). The primary outcome was more frequent in patients with diabetes (53% vs 21%; p=0.02), chronic kidney disease (33% vs 10%; p=0.034) and history of heart failure (13% vs 0%; p=0.025). LAS reservoir (LASr) and LAS conduct (LAScd) were lower in patients developing the primary outcome (21±7 vs 28.8±11%; p=0.017 and 7.7±3.9 vs 13.7±7%; p=0.007, respectively). On multivariate analysis, diabetes (HR 7.4, 95%CI 1.2-47; p=0.034)), LASr (HR 0.2, 95%CI 0.05-0.8; p=0.023), LAScd (HR 0.17, 95%CI 0.04-0.7; p=0.013) and LAS contraction (HR 0.2, 95%CI 0-05-0.8; p=0.025) were independent predictors of stroke recurrence or all-cause death after CS (Table). On long-rank test (using the discriminatory cut-off values of LASr &lt;23% and LAScd &lt;10%), LASr (p=0.009) (Figure 1) and LAScd (p=0.016) were associated with higher risk of the primary outcome.

Conclusion
Lower values of LAS reservoir, conduct and contraction are independently associated with higher risk of stroke recurrence or death after CS
Effect of intravenous iron-carbohydrate complexes in patients with heart failure with reduced ejection fraction and iron deficiency: a meta-analysis of randomized controlled trials
Authors: Kuno T O S H I K , Mototani R E N A , Watanabe A T S U Y U , Briasoulis A 
Published: November 2023

Abstract

Background
Iron deficiency (ID) has been associated with having the potential to cause heart failure as well as worsening heart failure with reduced ejection fraction (HFrEF). Treatment with a target on ID has been shown to lead to improvement in heart failure patient outcomes. In this study, we performed a meta-analysis of the RCTs to more comprehensively evaluate the effectiveness of intravenous iron-carbohydrate complexes in HF patients with ID.

Methods
We conducted a systematic literature search on MEDLINE and EMBASE. The search terms included "iron," "iron deficiency," "iron complex," "iron-carbohydrate," "iron sucrose," "heart failure," "HFrEF," and "intravenous." Included studies met the following criteria: (i) a study was published in a peer-reviewed journal; (ii) a study design was a randomized controlled trial; (iii) study enrolled patients with HFrEF and ID, and (iv) a study evaluated intravenous iron-carbohydrate complex. The primary outcome was all-cause mortality during the follow-up. The secondary outcomes were cardiovascular (CV) mortality (deaths due to CV causes), CV admission (hospitalizations due to cardiovascular causes), and HF admission (first hospitalizations due to HF or hospitalizations due to HF worsening). Risk ratios (RRs) with 95% confidence intervals (95%CIs) were calculated with the event/total number in each study and synthesized by a random-effects model.

Results
We identified 926 articles by the initial database search and additional manual search and retrieved the full text of 18 articles for further review. We then excluded 3 sub-analyses of the included trials to avoid patients’ duplications. Finally, we included 15 RCTs with a total of 3,085 patients (the median or mean age, 62–75 years; female, 25-55%; median follow-up duration, 2–141 weeks). Intravenous iron-carbohydrate complexes were associated with lower risks of all-cause mortality, CV mortality, CV admission, and HF admission, though statistical significance was only observed in HF admission (Figure A-D). CV admission and HF admission provided substantial heterogeneity.

Conclusion
The results of this meta-analysis showed that intravenous iron-carbohydrate complex therapy in patients with HFrEF and ID was beneficial in lowering the risk of hospitalization due to heart failure. Physicians should be aware of the significance of ID when treating patients with HFrEF.
Impact of the role of cardiology pharmacy specialist on the improvement of quality indicators among patients with heart failure and reduced ejection fraction
Authors: Yaseen I , Farhan H A 
Published: November 2023

Abstract

Background
2021 European Society of Cardiology quality indicators (QIs) for the care and outcomes of adults contains a domain for patients with heart failure with reduced ejection fraction (HFrEF) for initial treatment of guideline-directed medical therapy (GDMT) which includes beta-blocker (BB), angiotensin-converting enzyme inhibitor (ACEI) or angiotensin-neprilysin receptors inhibitors (ARNI), mineralocorticoid receptor antagonist (MRA), and sodium-glucose transporter-2 inhibitor (SGLT2i). The QIs for the individual GDMT is estimated by finding the proportion of patients with HFrEF who are prescribed each therapy in the absence of any contraindication.

Purpose
To identify the role of the board certified cardiology pharmacist (BCCP) on improving the quality indicators regarding the prescribing of GDMT among patients with HFrEF during hospitalization and before discharge.

Methods
A cross-sectional study was conducted at the cardiac care unit in a single heart center in Iraq between January 2021 to February 2023. Among the multidisciplinary team member at this unit is a BCCP who suggests optimization of medical therapy based on the recommendations of updated European or American guidelines for the management of different cardiovascular diseases including HFrEF. The suggestion then discussed with the cardiologists for agreement. The study included the medical records for patients with HFrEF and BCCP interventions whether the interventions regarding GDMT or other medical therapy interventions. Data were reviewed and were analyzed to identify the specific interventions related to the initiation of one or more GDMT in each patients.

Results
Among 164 patients with HFrEF with BCCP interventions, there were 102 (62%) patients who were eligible for one or more of the GDMTs prescription which was suggested by BCCP. The most GDMT initiated was MRA 53 (43%) among 123 interventions and in 53 (52%) of 102 patients (Figure 1). QIs were improved (100%) for BB, ACEI/ARNI, MRA, and SGLT2i among eligible patients as shown in table 1.

Conclusions
The role of BCCP is essential among heart team for improving QIs related to the GDMT prescription among patients with HFrEF based on the recommendations of the updated guidelines. BCCP mainly improved the QIs for the prescription of MRA.Frequency of GDMT Initiation by BCCPGDMT Initiation Reflecting Improved QIs
The effects of cardiovascular rehabilitation in patients with heart failure with reduced ejection fraction - does gender really matter?
Authors: Stojanovic M , Deljanin Ilic M , Vukovic A , Stankovic M , Igrutinovic Novkovic J , Igic I 
Published: November 2023

Abstract

Background
The prevalence of heart failure (HF) in the adult population appears to be 1-2%, and it rises with age. About ½ of HF patients have reduced ejection fraction (HFrEF). Although the positive effects of cardiac rehabilitation (CR) in patients with HFrEF are well known, women seem to participate in CR significantly less compared to men.

Purpose
To determine whether there is a difference in the effects of CR on the tolerance of physical strain and the quality of life (QOL) related to gender in examinees with HFrEF.

Methods
The study involved 225 pts with HFrEF, 190 men (84.4%) and 35 women (15.56%), who were referred to a three-week CR program. At baseline and the end of CR exercise stress test (EST) was taken. The QOL was assessed at the beginning and the end of CR by validated questionnaire Short-Form 36.

Results
Male pts showed better strain tolerance on the first and the second EST compared to female pts. However, both gender showed improvement in physical strain tolerance on the second EST by achieving higher strain level (men 2.17±0.85 vs. 2.56±0.88, p=0.000; women 1.74±0.7 vs. 2.14±0.77, p=0.001), and longer duration of EST (men 2.56±2.97 vs. 5.64±2.85, p=0.000; women 2.28±2.46 vs. 4.63±2.4, p=0.000). Also, significantly more male and female pts achieved submaximal heart rate on the second EST (p=0.000 for men, and p=0.046 for women). Furthermore, CR has led to an improvement in the QOL in both men and women. Namely, all parameters were better at the end of CR, both in men and women. However, statistically significant improvements in female pts were noted in physical functioning (40±16.96 vs. 70±6.12, p=0.034), and energy/fatigue (43±17.54 vs. 62±20.49, p=0.041). On the other hand, the statistical significance in male pts was reached in physical functioning (59.38±25.57 vs. 67.23±23.47, p=0.002), energy/fatigue (60.43±22.7 vs. 64.08±21.22, p=0.036), emotional well-being (71.31±20.97, vs. 74.29±21.18, p=0.011), body pain (63.64±26.95 vs. 71.93±23.58, p=0.000), and general health (48.94±14.7 vs. 55.27±18.1, p=0.000).

Conclusion
Women generally less participate in CR than men. Results indicated that CR improves exercise capacity and QOL in HFrEF patients, in both men and women. This is why CR needs improvement in the referral and participation of women.
Left atrial strain predicts fibrosis of left atrial appendage in patients with atrial fibrillation undergoing totally thoracoscopic ablation
Authors: Park S , Kim J H , Jeong D S , Chung S , Bak M J , Kim E K , Chang S A , Lee S C , Park S W 
Published: November 2023

Abstract

Background
Left atrial (LA) fibrosis is related with development and severity of atrial fibrillation (AF). The aim of this study was to investigated factors associated with LA fibrosis in patients undergoing totally thoracoscopic ablation (TTA) for AF.

Methods
Between February 2012 and March 2015, a total of 128 patients who underwent TTA were enrolled from a tertiary hospital. Left atrial appendage (LAA) was harvested during surgery to determine the degree of fibrosis. LAA fibrosis was classified as mild (1st quartile), moderate (2nd and 3rd quartile), or severe (4th quartile). Clinical outcome was 5-year recurrence rate of AF detected in electrocardiogram or 24-hour Holter monitoring.

Results
The mean age was 54.3 ± 8.8 years and 18.8% had paroxysmal AF. Patients with mild LAA fibrosis had a significantly lower rate of recurrent AF (23.3%) at 5 years after TTA compared with those with moderate (51.4%; hazard ratio [HR] 2.69; 95% confidence interval [CI] 1.19─6.12) or severe (53.2%; HR 2.84; 95% CI 1.16─6.97) fibrosis. Among clinical and echocardiographic parameters, peak LA strain was the only predictor of mild LAA fibrosis (coefficient 0.10, p=0.005) with the best cutoff value of 14.7% (area under the curve 0.732). The prevalence of mild LAA fibrosis was 40.6% in patients with peak LA strain ≥14.7%, but only 6.8% in those with peak LA strain &lt;14.7%.

Conclusions
In patients undergoing thoracoscopic ablation for AF, mild LAA fibrosis was associated with a lower risk of 5-year AF recurrence. LA strain is the only predictor of mild LAA fibrosis that reflects a lower risk of 5-year AF recurrence.
Left bundle branch area pacing in patients with CRT indication: short-term results & 1-year follow-up
Authors: Kataria V , Bhagwati M O H I T , Yaduvanshi A , Kitey P R I T A M 
Published: November 2023

Abstract

Background
Cardiac resynchronization therapy (CRT) using bi-ventricular pacing is class I recommendation for symptomatic patients with heart failure (LVEF ≤35%), QRS duration ≥150 msec and LBBB QRS morphology. Left bundle branch area pacing (LBBAP) has been reported as an alternative option for CRT. The aim of this study was to assess the feasibility and outcomes of LBBAP in patients eligible for CRT.

Methods
Patients with CRT indications were subjected to LBBAP. Peri-procedural outcomes & QRS duration were recorded. Changes in New York Heart Association (NYHA) class, need for HF hospitalization, echocardiographic data, lead-device parameters were evaluated at follow-up. HF status was assessed by clinical (no HF hospitalization and improvement in NYHA class) and echocardiographic response (≥5% improvement in LVEF).

Results
LBBAP was attempted in 16 patients (mean age 59.3 ±7.04 years, 37.5% women, ischemic cardiomyopathy in 33.3%). All patients had baseline LBBB. Pacing threshold and R-wave amplitudes were 0.8 ± 0.3 V at 0.5 ms and 12.1 ± 3.5 mV at implantation and remained stable during mean follow-up of 11.25 ± 3.7 (Range 6-18) months. LBBAP resulted in significant QRS narrowing from 147.5 ± 9.7 to 116 ± 10.2 ms (p &lt; 0.01). LVEF improved from 28.2 ± 2.8% to 38.9 ± 5.1% (p &lt; 0.01). Clinical and echocardiographic improvement was observed in 77% and 74% of patients, respectively.

Conclusions
LBBAP is feasible, safe and effective. It provides an alternative option for CRT. LBBAP provides low and stable pacing thresholds and is associated with improved clinical and echocardiographic outcomes.
Echocardiographic predictors of occult atrial fibrillation in patients with cryptogenic stroke
Authors: Kim P , Tao M , Gier C , Kemppainen C , Al-Sadawi M , Aslam F , Henriques M , Singh A , Almasry I , Dianati-Maleki N , Fan R , Rashba E , Kort S 
Published: November 2023

Abstract

Background
Left atrial (LA) strain has been proposed as an echocardiographic predictor of subsequent atrial fibrillation (AF) in patients presenting with cryptogenic stroke (CS). The purpose of this study was to compare the predictive value of LA strain parameters with traditional echocardiographic measurements for predicting occult AF in patients with CS.

Methods
We conducted a single-center retrospective cohort study of patients with cryptogenic stroke who underwent implantable cardiac monitor (ICM) placement. Transthoracic echocardiogram (TTE) parameters collected included mitral e and e’ velocities, and LA volume index (LAVI). LA strain was calculated offline using speckle-tracking in apical 4 and 2 chamber views, during the reservoir, conduit, and contractile phases of the cardiac cycle. Strain measurements obtained in each view were averaged (Figure 1). AF episodes had to last at least 2 minutes to qualify as an AF event.

Results
The cohort consisted of 269 patients with cryptogenic stroke who underwent ICM placement between April 2015 to December 2020, of them 45 patients had AF detected by ICM during follow-up. Echocardiographic evidence of dilated LA measured using LAVI (p=0.043) as well as lower filling pressures measured using e/e’ (p=0.033) were significantly associated with AF. (Table 1). LA function using strain in reservoir, conduit, and contractile phases was not significantly associated with AF (Table 1).

Conclusion
Increased LA size, but not abnormal LA function was significantly associated with incident AF in patients with CS.
Sex-related differences on short-term prognosis in patients with acute myocardial infarction related cardiogenic shock receiving Impella support in Japan
Authors: Nakamura M , Imamura T , Ueno H , Kinugawa K 
Published: November 2023

Abstract

Background
Sex-specific outcomes in patients with acute myocardial infarction related cardiogenic shock (AMI-CS) receiving temporary MCS remains controversial in the United States. Survival benefit of Impella support in female patients in Japan also remains uncertain.

Purpose
This study examined sex-related differences in clinical outcomes among patients with AMI-CS receiving Impella support using the prospective multi-center J-PVAD registry data.

Methods
We included patients with AMI-CS who received Impella-incorporated temporary MCS and were enrolled in the J-PVAD registry between Jan 2021 and Dec 2022. Patients with out-of-hospital cardiac arrest were excluded. The primary outcome was 30-day survival.

Results
A total of 979 patients (average 71 y; female 21%; LVEF 30%) were included. All patients received revascularization and 69% of them received during Impella support. Female patients had a lower 30-day survival compared to male patients (60.2% vs 67.9%, p = 0.0089). Of note, female patients who received Impella support before revascularization had a greater survival compared to those who received Impella support after revascularization (69.2% vs 41.8%, Figure 1).

Conclusions
Female patients in AMI-CS had a lower short-term prognosis compared to male. Early initiation of Impella support before revascularization is highly recommended for those with AMI-CS.