bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association of transaortic flow rate with outcomes in patients with moderate aortic stenosis
Authors: Kawada Y , Springhetti P , Tomaselli M , Portolan L , Penso M , Leonardi D , Clement A , Rota A , Scarsini R , Ribichini F , Muraru D , Benfari G , Badano L 
Published: January 2025

Abstract

Background
In patients with severe aortic stenosis (AS), the transvalvular flow rate (FR) is a key determinant of the prognostic value of the aortic valve area (AVA). However, the prognostic significance of FR in patients with moderate AS remains unclear.

Purpose
To assess the association with outcomes of FR in patients with moderate AS.

Methods
292 outpatients (mean age 80 ± 9 years, 45% female) with moderate degenerative AS (defined as AVA between 1 cm² and 1.5 cm²) underwent transthoracic echocardiography between January 2019 and July 2022 and were retrospectively included in this study. The FR was calculated using the derivation method [FRder= mean jet velocity (cm/s) x AVA(cm²)], and was validated in a random sample of 90 patients. In these patients, FR was also calculated using the direct method [FRdir = stroke volume (mL)/ejection time (s)]. The primary study endpoint was a composite of all-cause mortality and hospitalization for heart failure (HHF).

Results
After median follow-up of 19.3 (Interquartile-Range 12.3–26.0) months, 73 patients reached the primary endpoint, with 22 experiencing HHF and 51 deaths. Patients who met the combined endpoint had lower values of FRder compared to those who didn’t experience these outcomes (201±47 mL/s vs 225±48 mL/s). The FRder showed excellent correlation with FRdir (R²=0.93, p&lt;0.0001) (Figure 1). The best threshold value for identifying patients at higher risk of experiencing adverse outcomes of FRder was determined to be 210 mL/s through spline curve analysis.
Female sex [Odds Ratio (OR) 5.3 (C.I.95% 2.8-10.3), p&lt;0.0001], chronic kidney disease (eGFR&lt;60 ml/min) [OR 3.2 (C.I.95% 1.5-7.0), p=0.003], previous myocardial infarction (OR 3.9 [C.I. 95%1.7-8.6], p=0.001), stroke volume indexed (SVi) [OR 0.8 (C.I.95% 0.8-0.9), p&lt;0.0001] and at least moderate tricuspid regurgitation (OR 2.9 [C.I. 95% 1.2-6.8], p=0.017) resulted independent predictors of FRder less than 210 mL/s.
At Cox multivariable regression analysis, FRder less than 210 mL/s resulted associated with events (adjusted Hazard Ratio 2.17 [C.I. 95% 1.14 – 4.12], p=0.018), after adjustment for age, coronary artery disease, left-ventricular ejection fraction, right-ventricular dysfunction and low flow state-defined as SVi &lt;35 mL/m².

Conclusion
In patients with moderate degenerative AS under medical management, FRder less than 210 mL/s is independently associated with increased mortality and HHF at medium term follow-up. Further research is needed to determine whether patients with moderate AS and impaired flow rates might benefit from more intensive monitoring or earlier aortic valve replacement.
Figure 1
The role of cardiac magnetic resonance in cardiac arrest without initial underlying cause
Authors: Torremocha Lopez A , Cayetana Valbuena S , Dalmau Gonzalez-Gallarza R , Fernandez Gasso L , Refoyo Salicio E , Guzman Martinez G , Diaz Gonzalez L , Cuesta Lopez E , Rosillo Rodriguez S , Caro Codon J , Arbas Redondo E , Armada Romero E , Perez David E , Moreno Gomez J R 
Published: January 2025

Abstract

Introduction
The primary cause of sudden cardiac death is ischemic heart disease, but often we evaluate patients where this is excluded. Initial evaluation with echocardiogram may overlook certain morphological or functional alterations. Cardiac magnetic resonance (CMR) is recommended for survivors of cardiac arrest (CA) without a clear underlying cause (class I, level B). There is a lack of data from multicenter studies. Our aim is to assess whether CMR helps to clarify the aetiology of CA in our setting.

Methods
Retrospective observational study of survivors of CA with good neurological outcome with suspected cardiac cause admitted to Cardiology from October 2016 to April 2024. The patients did not show significant coronary lesions or those considered to be responsible for the arrest. CMR was performed for aetiological study and, on an individual basis, electrophysiology study, provocation test and/or genetics. Baseline characteristics and results of complementary tests were recorded.

Results
Thirty-two patients were included (figure 1). The average age was 50±9 years, over half were men (62,5%), and the majority had a shockable rhythm (87.5%). Genetic testing revealed a variant of uncertain significance or pathogenic in 40.6%. CMR found left ventricular (LV) systolic dysfunction in 31.3%, dilation in 18.8%, hypertrophy in 9.4%, and nonspecific morphological alterations in 9.4%. Similarly, right ventricular (RV) systolic dysfunction was observed in 9.4%, dilation in 6.3%, and morphological alterations in 6.3%. Diffuse fibrosis or interstitial disease was noted in 21.9%, edema in 18.8%, and late gadolinium enhancement in LV and/or RV in 40.6%. Figure 2 shows CMR diagnosis and final diagnosis based on initial suspicion. CMR reclassified 37.5% of patients and provided the diagnosis in 62.5% of patients.

Conclusions
CMR is a non-invasive test that constitutes a valuable tool in the context of initially non-ischemic CA, providing a comprehensive evaluation of cardiac structure, function, and tissue characterization. Routine use of CMR after CA decreases the percentage of patients classified as idiopathic ventricular fibrillation and reclassifies the diagnosis in more than a third, with consequences for the management and prognosis of the patient and their families.
Demographic data and complementary tests
Initial, CMR and final diagnosis
Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer?
Authors: Jassal D , Arya V , Mackic L , Telles-Langdon S M , Cheung D Y C , Ledingham A , Haasbeek P , Desautels D , Gordon V , Graham J , Green S , Grenier D , Kim C , Thiessen M , Pitz M 
Published: January 2025

Abstract

Introduction
Cardio-oncology focuses on the prevention, diagnosis, and management of cancer patients who are at risk of developing cardiovascular complications as a result of their anti-cancer treatment. Amongst the various pharmacological therapies which may prevent anthracycline mediated cardiotoxicity in women with breast cancer, including renin-angiotensin system (RAS) antagonists, beta blockers, and statins, there has been an increased interest on the role of nutraceuticals in this setting. Although we recently demonstrated the cardioprotective role of dietary flaxseed (FLX) in the prevention of adverse cardiovascular remodeling in a chronic in vivo female murine model of anthracycline mediated cardiotoxicity, little is known on the effects of this dietary agent in the clinical setting.

Purpose
The aim of the "Can flax "milk" prevent chemotherapy mediated cardiotoxicity in women with breast cancer (CANFLAX-BC)" study was to investigate whether consumption of FLX "milk" can prevent cardiac dysfunction in women with breast cancer treated with anthracyclines.

Methods
In this double-blinded, single centre, prospective randomized controlled clinical trial, women with breast cancer were randomized to oral consumption of either placebo oat fiber "milk" or FLX "milk" [each containing 30 grams of oat or flaxseed, respectively] for a total of 4 months while receiving anthracycline-based chemotherapy. Serial echocardiography was performed at baseline, 4-month, and 6-month follow-up.

Results
Between September 2021 and December 2023, a total of 21 women with early-stage breast cancer (EBC) (mean age 48±10 years, BMI 28±5 kg/m2) were enrolled in the CANFLAX-BC study. During the 4-month intake period, a total of 8 women received oat fibre "milk" and 13 women received FLX "milk", with a comparable adherence rate of approximately 70% for both groups. At baseline, 4-month, and 6-month follow-up, the LVEF was 68±4%, 69±3%, 66±4% for the oat fibre "milk" group, and 67±5%, 68±4%, 66±5% for the FLX "milk" group (no significant difference; Table 1, Figure 1A). Although the mean global longitudinal strain (GLS) was comparable between both groups at baseline, the GLS was significantly lower at -13.8±0.3% (4 months) and -15.1±0.3% (6 months) for the oat fibre "milk" group, as compared to a preserved GLS of -18.4±0.3% (4 months) and -18.5±0.2% (6 months) for the FLX "milk group (*p&lt;0.05; Table 1, Figure 1B).

Conclusion
In women receiving anthracycline based chemotherapy for breast cancer, FLX "milk" consumption prevents early cardiotoxicity, as reflected by the preservation of GLS parameters.
Table 1
Figure 1
Prognostic utility of non-invasive left atrial stiffness index in patients with heart failure with preserved ejection fraction: insights from EASY-HFpEF study
Authors: Takahashi T , Kusunose K , Kikuchi S , Iwahashi N , Kinugasa Y , Dohi K , Takase H , Inoue K , Okumura T , Kitada S , Seo Y , Sata M , Ohte N 
Published: January 2025

Abstract

Background
It is known that an increase left atrial stiffness is associated with poor prognosis in patients with heart failure with preserved ejection fraction (HFpEF).

Purpose
We evaluated the predictive utility of non-invasive left atrial stiffness index (LASI) in HFpEF patients, comparing it to other clinical prognostic indicators.

Methods
Patients were recruited from the EASY-HFpEF study, a multicenter prospective observational cohort study in Japan involving patients hospitalized with acute decompensated heart failure and a left ventricular ejection fraction of &gt;40%. Among the patients in the study, those with registered echocardiographic image data of sufficient quality were analyzed for left atrial strain. The LASI was calculated as the ratio of E/e’ to the left atrial reservoir strain. The primary endpoint was a composite outcome of all-cause death and readmission due to heart failure during the 2-year follow-up period.

Results
We analyzed 95 patients, with a median age of 75 years and including 41% female patients. LASI was associated with an increased risk of composite outcome (adjusted HR 1.10 [95%CI; 1.04-1.17, P=0.001] per 0.1 increase). LASI was non-inferior in predictive ability compared to predictors such as B-type natriuretic peptide (BNP) and H2FPEF score. (AUCLASI=0.79, AUCBNP=0.80 [vs.AUCLASI, P=0.775], AUCH2FPEF =0.75 [vs.AUCLASI, P=0.342]) (Figure 1). The addition of LASI significantly improved the prognostic power of a model containing BNP and H2FPEF score (model of BNP+H2FPEF score, χ2=29.3; model of BNP+H2FPEF+LASI, χ2=40.5, P=0.004) (Figure 2).

Conclusion
Non-invasive LASI in HFpEF patients is associated with increased risks of all-cause mortality and heart failure readmission, its potential utility in predicting these adverse events.
The importance of lung ultrasound in diagnosing the causes of shortness of breath in patients with heart failure
Authors: Szyszkowska A , Olesiewicz T O , Plonska Korabiewska I P K , Tarasiuk E T , Knapp M K , Sobkowicz B O , Lisowska A L 
Published: January 2025

Abstract

Introduction
Heart failure is a progressive chronic disease affecting up to 10% of the population over the age of 70 in developed countries. It is associated with frequent hospitalizations and a poor prognosis. One of the main symptoms reported by patients with heart failure is dyspnea. In daily practice, there are problems with adequately diagnosing and treating patients with heart failure with preserved and mildly reduced ejection fractions (HFpEF and HFmrEF).

Purpose
This study aimed to assess the usefulness of lung ultrasound (LUS) in diagnosing heart failure with preserved and mildly reduced ejection fraction and determine its correlation with NTproBNP and echocardiographic markers.

Methods
The research was conducted on 143 patients hospitalized between 2018 and 2020, admitted due to shortness of breath, and diagnosed with HFpEF and HFmrEF. Venous blood was collected from all participants to obtain basic biochemical parameters and NTproBNP. Moreover, all participants underwent echocardiography and transthoracic lung ultrasound.

Results
Assessment of the number of B-lines on lung ultrasonography at admission was characterized by high diagnostic value indicating exacerbation of heart failure symptoms, both in patients with HFpEF and HFmrEF. There were no statistically significant differences in the number of B-lines in LUS at admission in patients with EF ≥ 50% and with EF 41-49%. The number of B-lines on lung ultrasound ≥ 14 was determined as a cut-off point, indicating an increased risk of death during the 2-year follow-up period. Factors that significantly impacted mortality in the study patient population were patient age and the difference between the number of B-lines on ultrasound at admission and at hospital discharge.

Conclusions
Lung ultrasonography provides good diagnostic value in patients with HFpEF or HFmrEF and exacerbation of heart failure symptoms and may be considered as a prognostic marker in these groups of patients.
B-lines in LUS relative to NYHA class B-lines in LUS relative to risk of death
Left atrial function parameters in patients with a first episode of myocardial infarction: relationship with infarct size and serological inflammatory biomarkers
Authors: Islas F , Davila C , Martinez E , Gil-Abizanda S , Cachofeiro V , Poveda V , De Agustin J A , Luaces M , Olmos C 
Published: January 2025

Abstract

Aim
Left atrial (LA) function is linked with clinical events in different cardiovascular scenarios. Our aim was to evaluate the associated between LA function and different imaging and serological biomarkers in a cohort of patients with a first episode of acute myocardial infarction (AMI).

Methods
Prospective cohort of patients with a first episode of AMI treated with percutaneous revascularization in a tertiary care hospital in 2016. All patients underwent echocardiography and cardiac magnetic resonance and blood samples were taken for serological biomarkers analysis.
LA function was assessed by means of LA stiffness (E/e’ divided by LA reservoir strain) and LA volumetric-mechanical coupling index [LACI] (LA volume index divided by tissue Doppler a’).

Results
Mean age of patients in our cohort (n=41) was 57.5±10 years, and 38 (93%) were male.
64% of patients had single vessel coronary artery disease, and median LVEF eas 58% (55-62).
Regarding LA function, median LACI was 2.47 (1.99-3.14) and median LA stiffness was 0.27 (0.21-0.44), with 11 (26.8%) patients fulfilling criteria for high LA stiffness.
The correlation between these parameters and different imaging and serological biomarkers is shown in Figure 1. There was a significant correlation between LA stiffness and ventricular-arterial coupling, infarct size, and T1 native values.
LACI was associated with pulmonary artery systolic pressure, interleukin-6 and soluble CD-14 antigen. Both LA parameters were also significantly associated with left ventricular (LV) ejection fraction and LV global longitudinal strain (Figure 2).

Conclusions
In our cohort of patients with a first episode of AMI, echocardiographic parameters of LA function were significantly associated with LV function, infarct size and serological biomarkers of inflammation.
These parameters might serve as an additional tool for risk stratification in patients with ischemic cardiomyopathy.
Figure 1
Figure 2
Clinical significance of right ventricular - pulmonary arterial uncoupling in hypertrophic cardiomyopathy
Authors: Timoteo A , Aguiar Rosa S , Moura Branco L , Galrinho A , Rio P , Cruz Ferreira R 
Published: January 2025

Abstract

Background
Right ventricular (RV) – pulmonary arterial (PA) coupling represents the relationship between RV function and the afterload in the pulmonary vascular system. It is a non-invasive surrogate on how the RV is adapted to an increased afterload in the pulmonary circulation. In cases of exhaustion of compensatory RV remodeling, the ratio decreases and there is RV-PA uncoupling. Several studies reported the usefulness of this parameter in patients with heart failure, including in preserved ejection fraction. There is no evidence regarding the association between RV-PA coupling and hypertrophic cardiomyopathy (HCM). We aimed to evaluate this parameter in patients with HCM.

Methods
This prospective cohort study enrolled patients with HCM without obstructive epicardial coronary artery disease, that underwent a comprehensive evaluation. Echocardiography was used to assess RV-PA coupling as the ratio of tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP). In addition, coronary flow reserve in the left anterior descending artery (CFR_LAD) was also evaluated: diastolic coronary flow velocity was measured in basal conditions and in hyperemia and CFR was calculated as the ratio of hyperemic and basal peak diastolic flow velocities. This was used as a surrogate marker of coronary microvascular dysfunction. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET). Cardiac magnetic resonance (CMR) was also performed to evaluate RV function (volumes and ejection fraction), and the extent of late gadolinium enhancement (LGE) in the left ventricle (LV).

Results
We enrolled 62 patients, with a mean age of 55 (15) years, 64% males. In 64% it was an asymmetrical septal hypertrophy phenotype, in 31% an apical hypertrophy, and in 27%, it was an obstructive HCM. Mean TAPSE/PASP was 0.556 (0.23) and median was 0.50. All patients had a normal LV ejection fraction. TAPSE/PASP showed a modest predictive accuracy for peak VO2 &lt; 20 ml/Kg/min, a marker of decreased functional capacity (AUC 0.671, 95% CI 0.535 – 0.807, p=0.022), with the best cut-off set at 0.60 (sensitivity 85% and specificity 47%). By univariable linear regression analysis, peakVO2 was correlated with age, male gender, E/E’, indexed left atrial volume, indexed right ventricle end-systolic and end-diastolic volumes, CFR_LAD and TAPSE / PASP. The HCM phenotype or the presence of obstruction were not associated with peakVO2. Multivariable stepwise linear regression analysis showed that the independent predictors of peakVO2 were male gender (b-estimate: 0.305, p=0.002), age (b-estimate: - 0.323, p=0.002), RV indexed end-diastolic volume (b-estimate: 0.200, p=0.043) and TAPSE/PASP (b-estimate: 0.275, p=0.005).

Conclusion
In patients with HCM, RV-PA uncoupling is associated with a reduction in functional capacity. Therefore, it is a marker of disease severity.
Effect of antiretroviral treatment in myocardial function of treatment naive patients with HIV
Authors: Ikonomidis I , Katogiannis K , Pavlidis G , Thymis J , Katsanaki H , Kostelli G , Michalopoulou H , Vlachomitros D , Kavatha D , Antoniadou A 
Published: January 2025

Abstract

Background/Aim
HIV infection is related with cardiovascular adverse events. We investigated the effects of antiretroviral treatment in myocardial and vascular function of newly diagnosed patients with HIV.
Patients and methods: A total of 70 newly diagnosed HIV patients were enrolled. Patients were randomized to 4 different treatments which were descovy plus resolsta (emtricitabine/ tenofovir alafenamide), tivicay plus descovy (tenofovir alafenamide/ emtricitabine), genvoya (elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide) and descovy plus isentress (raltegravir). We measured at baseline and 12 months posttreatment: (a) Left Ventricular (LV) Global Longitudinal Strain (GLS), (b) LV Global Work Index (GWI), Global Constructive Work (GCW), Global Wasted Work (GWW), Global Work Efficiency (GWE). At baseline, we compared the HIV patients with 35 healthy matched controls.

Results
At baseline patients with HIV had devastated myocardial function, endothelial function and endothelial glycocalyx compared with healthy controls.
Twelve months after intervention HIV patients improved myocardial function, as assessed by GLS, GWI and GCW as well as endothelial function as evaluated by decrease of PBR5-25.
Nevertheless, in HIV patients 12 months post treatment myocardial and endothelial function and endothelial glycocaylyx was impaired in comparison with healthy controls.

Conclusions
Treatment with antiretroviral therapy partially improves myocardial and arterial function 12 months post treatment.
Expanding the triglyceride range in clinical trials: therapeutic opportunities
Authors: Nordestgaard Ask T , Pradhan Aruna D , Everett Brendan M , MacFadyen Jean G , Bhatt Deepak L , Visseren Frank L J , Libby Peter , Santos Raul D , Nissen Steven E , Nordestgaard Børge G , Ridker Paul M 
Published: January 2025

Abstract

Background and Aims
Guidelines focus on individuals with triglycerides between 2.3 and 5.6 mmol/L (200 and 499 mg/dL). The hypotheses that triglycerides across the full biological range and within this constrained range associated with cardiovascular risk were re-assessed.

Methods
Multivariable-adjusted hazard ratios for major cardiovascular events and death according to baseline triglycerides among 119 573 individuals with triglycerides across the full biological range from the Copenhagen General Population Study, among 27 757 individuals with baseline triglycerides between 2.3 and 5.6 mmol/L from the Copenhagen General Population Study and the Women’s Health Study cohorts, and among 31 272 individuals with mild-to-moderate hypertriglyceridaemia from the PROMINENT, REDUCE-IT, and STRENGTH trials were calculated.

Results
Increasing triglycerides across the full range (0.3 to 11.2 mmol/L) were associated with an increasing risk of major cardiovascular events (N = 12 241). In the cohorts, combined hazard ratios [95% confidence interval (triglyceride range in mmol/L)] for major cardiovascular events (N = 3928) from lowest to highest triglyceride quartile were 1.0 [referent (range: &lt; 2.5)], 0.95 [0.87–1.04 (range: 2.5 to &lt;3.0)], 1.04 [0.95–1.13 (range: 3.0 to &lt;3.6)], and 1.13 [1.04–1.23 (range: ≥ 3.6)]. In the three contemporary trials, the corresponding hazard ratios (N = 4265 cardiovascular events) from lowest to highest quartile were 1.0 [referent (ranges for PROMINENT/REDUCE-IT/STRENGTH: &lt; 2.6/2.0/2.2)], 1.01 [0.93–1.10 (ranges: 2.6 to &lt;3.1/2.0 to &lt;2.5/2.2 to &lt;2.7)], 1.05 [0.96–1.14 (ranges: 3.1 to &lt;3.9/2.5 to &lt;3.1/2.7 to &lt; 3.5)] and 1.09 [1.00–1.19 (ranges: ≥ 3.9/3.1/3.5)]. In neither cohorts nor trials were triglycerides across this range strongly associated with risk of cardiovascular or all-cause death.

Conclusions
Individuals with mild-to-moderate hypertriglyceridaemia may not express the same magnitude of cardiovascular risk as that observed across the full range of plasma triglycerides. Future triglyceride-lowering therapy trials may want to consider enrolment across a wider range of triglyceride levels if there is no prior history of pancreatitis nor excessive alcohol intake.