bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hepatic venous stasis index reflects hepatic congestion and predicts adverse outcomes in patients with heart failure
Authors: Ohara H , Yoshihisa A , Sugawara Y , Ichijo Y , Sato Y , Misaka T , Sato T , Oikawa M , Kobayashi A , Takeishi Y 
Published: November 2023

Abstract

Background
It has been reported that the hepatic vein waveforms determined by abdominal ultrasonography can assess hepatic congestion in heart failure (HF) patients. However, the parameter which quantifies hepatic vein waveforms has not been established. We suggest hepatic venous stasis index (HVSI) as the novel indicator to evaluate hepatic congestion quantitatively. To examine the clinical significance of HVSI in HF patients, we aimed to clarify the associations of HVSI with parameters of cardiac function and right heart catheterization (RHC), as well as that with prognosis, in patients with HF.

Methods
We performed abdominal ultrasonography, echocardiography and RHC in patients with HF (N = 513). The patients were divided into three groups based on HVSI as follows; HVSI 0 (HVSI = 0, N = 253), low HVSI (HVSI 0.01–0.20, N = 132) and high HVSI (HVSI &gt; 0.20, N = 128) as shown in Figure 1. We examined the associations of HVSI with parameters of cardiac function and RHC, and followed up for cardiac events defined as cardiac death or worsening HF.

Results
There were significant correlations between HVSI and mean right atrial pressure (R = 0.244, P &lt; 0.001), right ventricular fractional area change (R = -0.195, P &lt; 0.001) and inferior vena cava diameter (R = 0.318, P &lt; 0.001). During the follow-up period, cardiac events occurred in 87 patients. In the Kaplan–Meier analysis, cardiac event rate increased across increasing HVSI (log-lank, P = 0.002, Figure 2). In the multivariate Cox proportional hazard analysis, high HVSI was independently associated with cardiac events (high HVSI group vs. HVSI 0 group: hazard ratio, 1.746; 95% confidence interval, 1.053–2.894, P = 0.031).

Conclusions
HVSI assessed by abdominal ultrasonography reflects hepatic congestion and right-sided HF, and is associated with adverse prognosis in HF patients.Figure 1Figure 2
Association between speckle tracking echocardiography and pressure-volume loop derived parameters at increasing levels of myocardial damage in a porcine model of acute cardiogenic shock
Authors: Hartmund Frederiksen P , Linde L , Gregers E , Udesen N L J , Helgestad O K L , Banke A B S , Dahl J S , Jensen L O , Lassen J F , Povlsen A L , Larsen J P , Schmidt H , Ravn H B , Moller J E 
Published: November 2023

Abstract

Background
Echocardiography is a diagnostic cornerstone in acute cardiovascular care. However, the relationship between speckle tracking assessed global longitudinal strain (LS) and Doppler-based echocardiography with basic physiological markers of cardiac function derived from pressure-volume loops remains poorly elucidated, especially with increasing levels of myocardial damage.

Objectives
We aimed to describe the association between LS and Doppler-based echocardiography and direct measurements of central hemodynamic parameters from conductance catheter-based pressure-volume loops in an animal model with increasing left ventricular (LV) dysfunction.

Methods
Twelve Danish landrace pigs weighing 75-80 kg were used. All instrumentations were performed percutaneously, including placement of a conductance catheter in the LV. Progressive LV dysfunction was induced by stepwise embolization trough the left main coronary artery every three minutes until a 50% reduction in cardiac output or mixed venous saturation, compared to baseline, or a mixed venous saturation &lt;30%. Echocardiography was performed through a subxiphoid midline incision, and was done at baseline and 90 seconds after each injection.

Results
With progressive LV dysfunction, mean cardiac output decreased from 5.6 l/min (SD: 0.9) to 2.1 l/min (SD: 0.9) and mean mixed venous saturation deteriorated from 61.1%(SD: 7.9) to 35.3% (SD: 6.1). Mean LS and LV outflow tract velocity time integral (LVOT VTI) declined from -13.8% (SD 3.0) to -6.1% (SD: 2.0) and 16.9 cm (SD: 2.6) to 7.8 cm (SD: 1.8), respectively (Figure 1). LS and LVOT VTI showed the strongest correlation to stroke work in unadjusted univariate regression (r2=0.53 and r2=0.49, respectively. p&lt;0.01 for both). LS correlated significantly, but modest, with stroke volume (r2=0.46, p&lt;0.01), end-systolic elastance (r2=0.32, p&lt;0.01), systolic blood pressure (r2=0.37, p&lt;0.01), ventriculo-arterial coupling(r2=0.34, p&lt;0.01), and arterial elastance (r2=0.23, p&lt;0.01) (Figure 2). In a multivariate regression analysis, LS showed significant correlation with stroke work, systolic blood pressure, and end-diastolic wall stress (r2=0.60, p&lt;0.01).

Conclusion
In an animal model of acute progressive LV dysfunction, echocardiographic and conductance catheter-based measurements changed significantly. LS and LVOT VTI displayed the earliest and the largest alterations with increased myocardial damage and LS showed moderate correlations with contractility, arterial elastance and ventriculo-arterial coupling. This indicates that LS is a marker of overall ventricular performance.Echocardiographic changes from baselineScatter plot of LS and hemodynamics
MCS current practice and weaning: CCCTN survey of CICU directors at academic medical centers
Authors: Balgobind A , Pierce M , Alvarez Villela M 
Published: November 2023

Abstract

Background/Introduction
As the treatment of cardiogenic shock evolves, temporary mechanical circulatory support (MCS) use is increasing. Few studies have examined Cardiac Intensive Care Unit (CICU) practices for management and weaning of MCS.

Purpose
We aimed to describe current management and weaning practices for patients supported with an intra-aortic balloon pump (IABP) or Impella in CICUs.

Methods
During December 2022, a 45-question survey was electronically distributed by the Critical Care Cardiology Trials Network (CCCTN) to the CICU directors of 44 academic medical centers in North America. Descriptive statistics were used to summarize the results.

Results
A response rate of 84% was achieved. Among respondents, CICU bed capacity ranged from 8-32 (Mean of 17). Staffing was primarily by cardiologists without board certification in heart failure or critical care (38%). One-in-four centers reported staffing by a multi-disciplinary team consisting of cardiologists and intensivists. Most centers use heparin anticoagulation for both IABP (32, 87%) and Impella (32, 91%) and primarily used PTT to monitor anticoagulation (23, 62%) with a target of 50-70 seconds (27, 73%). While using Impella support, daily TTE (29%), plasma free hemoglobin measurements (34%) and prophylactic antibiotics (3%) were uncommon. Most institutions did not have a formal weaning protocol for IABP (78%) or Impella (66%). The majority of centers reported IABP weaning to be a subjective decision led by the CICU attending (65%), while Impella weaning was commonly a decision made by a multi-disciplinary team including the CICU attending (57%). PACs are used routinely when weaning Impella (83%) but not IABP (46%). IABP removal is most commonly done at bedside by CICU team (70%), whereas Impella removal is most commonly done in the catheterization laboratory (43%).

Conclusions
In this survey of academic CICUs, IABP and Impella management showed substantial variability across centers. Use of invasive hemodynamic monitoring was common but its use during weaning was not uniform. Multidisciplinary involvement was more common with Impella support and weaning when compared to IABP. These heterogeneous results highlight the need for further investigation to guide best practices in MCS management.
Validating the association between a composite metric of guideline-directed medical therapy (GDMT) and clinical outcomes for patients with heart failure with reduced ejection fraction (HFrEF)
Authors: Calma J , Hsiao S , Varshney A S , Azizi Z , Golbus J R , Heidenreich P A , Sandhu A T 
Published: November 2023

Abstract

Introduction
A composite metric to characterize the overall quality of GDMT for patients with HFrEF is important to evaluate quality-of-care and for clinical research.

Purpose
We sought to evaluate the associations between GDMT scores and cardiovascular outcomes amongst patients with recently-diagnosed HFrEF within a large national integrated health system within the United States.

Methods
We identified a cohort of patients with recent-onset HFrEF who received care within the Veterans Affairs system between January 2013 and June 2019. We excluded patients with systolic blood pressure &lt;100mmHg or glomerular filtration rate &lt;30 mL/min/1.73m2. We identified active medical therapy based on the last medication fill 90-180 days after the index date (first date with documented HF diagnosis and EF≤40%). We calculated three different GDMT scores: the original Heart Failure Collaboratory Score, the 4-Pillar Intensification Score, and a modified 4-Pillar Intensification Score that included continuous scoring to further incentivize dose uptitration (Figure 1). Using a landmark analysis, we evaluated the association between a 1 standard deviation (SD) change in the GDMT scores at 6 months with the following outcomes: all-cause death, cardiovascular death, and the composite of cardiovascular death/heart failure hospitalization. We repeated the analyses with adjustment for comorbidities and vital signs.

Results
Among 108,752 patients with recent-onset HFrEF, the mean age was 70.0 years (SD: 11.1) and 97.6% were men. Treatment rates were the following: evidence-based beta-blockers – 55.2%, renin-angiotensin system inhibitors – 60.2%, angiotensin neprilysin inhibitors – 2.9%, mineralocorticoid receptor antagonists – 17.6%, sodium glucose transporter 2 inhibitors – 0.7%, hydralazine/nitrates – 4.9%, and ivabradine – 0.1%. A one standard deviation increase in each of the GDMT scores was associated with improved clinical outcomes (Table 1). Figure 1 illustrates the association between the modified 4-Pillar Intensification Score and the composite of cardiovascular death/heart failure hospitalization. These associations were attenuated but remained significant with comorbidity adjustment. Results also remained consistent when the study period was restricted to 2016 or later and with inclusion of the last prescription fill between 1-180 days post-index date.

Conclusion
Our study suggests that GDMT scores are consistently associated with clinical outcomes among patients with HFrEF.
Transcatheter edge to edge repair of functional mitral regurgitation as bridge to heart transplantation: 2-years follow up results from MitraBridge international registry
Authors: Marcelli C , Munafo' A R , Estevez-Loureiro R , Adamo M , Guerin P , Arzamendi D , Ho E C , Asgar A , Petronio A S , Grasso C , Van Mieghem N M , Tarantini G , Potena L , Saia F , Godino C 
Published: November 2023

Abstract

Background
Chronic severe functional mitral regurgitation (FMR) is a common finding in patients with advanced heart failure (AHF) who undergo evaluation for heart transplantation (HTx). Nevertheless, access to surgical strategies for AHF could be limited by scarce availability of donors and by temporary or definitive contraindications. MitraBridge registry already proved that transcatheter edge to edge repair (TEER) of FMR performed as a bridge to HTx is an effective and safe treatment strategy at 1-year follow up with 64% of patients free from composite primary endpoint of all-cause death, new admission for HF, urgent HTx or LVAD implantation.

Purpose
The aim of this study is to determine whether 1-year results of MitraBridge registry were maintained at 2-years follow up.

Methods
Mitrabridge is a retrospective, multicenter observational study that enrolled 153 adult patients with AHF and moderate-to-severe or severe FMR and considered candidates for HTx who underwent TEER between 2018 and 2021. Depending on the strategy TEER was performed for, patients were classified in bridge to transplant, candidacy or decision. Primary endpoint of the current analysis was the 2-year composite rate of all-cause death, new admission for HF, urgent HTx or LVAD implantation.

Results
Median age was 59 years old [53-63], most patients were in INTERMACS class 5-6 (47.5%) and mean left ventricle ejection fraction (LVEF) was 26.9±7.7%. Baseline right heart catheterization was available for 112 (73%) patients, of them 87.5% had pulmonary hypertension with mean pulmonary artery pressure (mPAP) of 33±10 mmHg. Procedural success was achieved in 89.5% of cases and no deaths at 30 days were reported. At 2-years follow up, freedom from primary endpoint was maintained in 47% of patients. A significant reduction of echocardiographic systolic pulmonary artery pressure (sPAP) was observed (from 50 [40-61] mmHg to 43 [33-53] mmHg, p-value&lt;0.001). At the end of follow-up (median time of 26 months, IQR 9-52), elective HTx was successfully performed in 30 cases (21%), 19 patients (13.5%) maintained or obtained the eligibility for transplant, and 32 patients (22.5%) had no longer indication for HTx, due to clinical improvement. Nine patients underwent LVAD implantation for clinical worsening and nine (8%) urgent HTx (15% of already listed population).

Conclusions
MitraBridge 2-years follow up confirms that TEER is a safe option in AHF population with FMR and shows that haemodynamic and clinical benefits following the procedure are maintained at long term. In particular, it allowed 21% of patients to receive elective HTx reducing need for urgent organ transplantation and helped to expand the candidacy for HTx.
Association between obstructive sleep apnea and heart failure in patients with and without obesity: a population-based cohort study
Authors: Kim K 
Published: November 2023

Abstract

Background
Obstructive sleep apnea (OSA) is a prevalent disorder characterized by partial or complete airway collapse during sleep, which often leads to sleep disruption and intermittent hypoxia. Previous research has suggested that patients with heart failure (HF) are more likely to have OSA. However, not enough evidence is available for association between new-onset OSA and HF. A recent Danish cohort study found that OSA, without continuous positive airway pressure therapy, is linked to a higher risk of HF across all age groups (1). In addition, the association between OSA and HF in patients with and without obesity has not been extensively studied in a large Asian cohort.

Purpose
To investigate the association between obstructive sleep apnea (OSA) and heart failure (HF) in a large Asian cohort stratified by obesity, as defined by World Health Organization (WHO) criteria for the Asian population, in both patients with and without obesity.

Methods
Using a nationally representative cohort of Korean adults over 40 years old who underwent national health screening between 2009 and 2010 with no prior history of HF or cardiovascular disease, we identified OSA using outpatient visit records (ICD-10: G47.3). Participants were tracked from January 1, 2011 to December 31, 2019 for new HF events, death from HF or other causes, or the end of follow-up, whichever occurred first. A Cox proportional hazards model adjusted for sociodemographic factors, health status, health behavior, and family history of heart disease was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). Obesity was defined as a body mass index greater than 25.0 kg/m2 based on WHO criteria for the Asian population.

Results
The final study population included 326,662 participants (32.7% of them were with obesity). Among obese patients, those with OSA had a higher risk of developing HF (HR=1.52; 95% CI: 1.07-2.19) than those without OSA. The association between OSA and HF was less pronounced in non-obese patients (HR=1.07; 95% CI: 0.65-1.78 for HF in patients with OSA compared to those without OSA) with a significant interaction between obesity and OSA-HF association (P-value for interaction&lt;0.001).

Conclusions
Our findings suggest that OSA is linked to an increased risk of HF, particularly in obese patients. Further research is necessary to examine important clinical subgroups regarding prevention of HF in patients with OSA.
Comparison of supine bicycle exercise versus treadmill exercise echocardiography in a cycling-naive population
Authors: Monteagudo Ruiz J M , Gonzalez Gomez A , Garcia Martin A , Hinojar Baydes R , Casas Rojo E , Jimenez Nacher J J , Martin Vives P , Zamorano J L , Fernandez-Golfin C 
Published: November 2023

Abstract

Introduction
Exercise echocardiography is a useful diagnostic test for the evaluation of coronary artery disease. Supine bicycle exercise echocardiography has the advantage of continuous monitoring of wall motion during exercise. On the contrary, the heart rate and workload is usually lower compared to treadmill exercise, especially between patients not used to cycling as is the case of many old adults. The aim of this study is to compare both exercise modalities.

Methods
A group of consecutive patients with chest pain underwent supine bicycle exercise echocardiography under a protocol adapted to the individual requirements. The operator chose between three protocols: light (5 watts every minute), medium (5 watts every 30 seconds) or intensive (10 watts every 30 seconds) according to age, sex and physical condition. The other group underwent treadmill exercise echocardiography using the Ball State University/Bruce Ramp protocol.

Results
A total of 902 patients were included. Of them, 258 patients underwent supine bicycle exercise echocardiography and 644 patients underwent treadmill exercise echocardiography. Mean age was 62.1 years (SD=13.4) and 48.5% of patients were women. Baseline characteristics were comparable in both groups, without significant differences regarding age, sex, body mass index, pre-test probability or image quality. There were no significant differences in the percentage of positive tests (5.0 vs. 5.3%, p = 0.883). However, the percentage of patients that achieved at least 85% of the predicted workload was significantly higher in the group of treadmill exercise echocardiography (91.3 vs. 45.0%, p &lt; 0.001). The percentage of patients that achieved at least 85% of the age-predicted maximum heart rate was also significantly higher in the group of treadmill exercise echocardiography (76.7 vs. 44.2%, p &lt; 0.001).

Conclusions
This study suggests that in a population not used to cycling, the use of supine bicycle exercise echocardiography, as opposed to the use of treadmill, hinders the achievement of an adequate maximum heart rate and workload, which can lead to inconclusive results. This should be considered while selecting the ischemic test to use.
Impact of systemic lupus erythematosus on outcomes in patients hospitalized with acute decompensated heart failure with reduced and preserved ejection fraction: a national inpatient sample study (2016)
Authors: Nomigolzar S , Nomigolzar R , El Sharu H , Subramanian L 
Published: November 2023

Abstract

Background
Systemic lupus erythematosus (SLE) is known to have an impact on cardiovascular outcomes, but its effect on patients with acute decompensated heart failure (ADHF) with reduced and preserved ejection fraction is not well understood. This study aims to investigate the impact of SLE on in-hospital outcomes in patients with ADHF.

Methods
This retrospective cohort study analyzed data from the United States National Inpatient Sample Database from 2016 to 2020. Patients hospitalized with ADHF with reduced and preserved ejection fraction were identified using ICD-10 codes and then categorized based on SLE diagnosis. Mortality and in-hospital complications were analyzed using multivariate logistic regression.

Results
Out of 10,700,000 ADHF hospitalizations, 0.61% (65,270) were associated with SLE. Compared to patients without SLE, those with SLE were younger (61 vs 72 years old, p&lt;0.001), more likely to be female (85% vs 48%, p&lt;0.001), had longer lengths of stay (coefficient: 0.23; p 0.005), and lower total hospital charges (coefficient: -$5,207; p&lt;0.001). Patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke (Figure 1). However, they had higher odds of in-hospital mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. No significant differences were found in respiratory failure and intracranial hemorrhage rates between the two cohorts.

Conclusions
This study suggests that the presence of SLE in patients hospitalized with ADHF is associated with worse in-hospital outcomes, including higher rates of all-cause mortality, gastrointestinal bleeding, blood transfusion, pericardial complications, and AKI. However, patients with SLE had lower rates of cardiogenic shock, acute MI, and ischemic stroke compared to those without SLE. These findings highlight the importance of early recognition and aggressive management of SLE in patients with ADHF to improve outcomes. Further research is needed to identify potential interventions that could improve the outcomes of this high-risk population.
Obesity and outcomes in cardiogenic shock due to acute myocardial infarction
Authors: Guglin M , Li B , Kanwar M , Abraham J , Kataria R , Bhimaraj A , Vallabhajosyula S , Kapur N 
Published: November 2023

Abstract

Background
Obesity paradox in heart failure (HF) is defined as better outcomes associated with higher body mass index (BMI).

Purpose
We explored the relationship between BMI and outcomes in cardiogenic shock (CS) due to acute myocardial infarction.

Methods
The Cardiogenic Shock Working Group (CSWG) registry includes patients with CS, regardless of etiology, from 17 clinical sites across the USA. In- hospital mortality, as a main outcome measure, was analyzed depending on BMI as a continuous variable, as well as BMI quartiles (BMI≤24.4 kg/m2, 24.433.1 kg/m2) for the subset of CS due to acute myocardial infarction (AMI-CS). We also explored mortality in categorized BMI subsets (underweight, normal weight, overweight, obese, and morbidly obese).

Results
A total of 969 patients with AMI-CS were included. The in-hospital mortality was 42.4%. When analyzed as a continuous variable, BMI had no association with survival to discharge. When the cohort was divided into quartiles according to BMI, mortality was consistent with 42.2%, 38.5%, 39.5%, and 49.3%, respectively, p=0.082. In categorized subsets, mortality was 30% in the underweight, 42.9% in the normal weight, 37.4% in the overweight, 44.5.% in the obese, and 47.9% in morbidly obese, p=0.15.

Conclusions
In acute myocardial infarction-related cardiogenic shock, obesity creates no survival advantage.