bluuebunny/crossref_metadata_2025_split huggingface dataset:
ACUTE HF score predicts in-hospital mortality in patients with acute heart failure
Authors: Pastore M C , Mandoli G E , Campora A , Renzelli A , Olivoni G , Toscano M , Pavoncelli S , Delcuratolo E , Lambardi M , Morrone F , Cavigli L , Focardi M , D'ascenzi F , Valente S , Cameli M 
Published: November 2023

Abstract

Background
ACUTE HF is a multiparametric score combining clinical, biochemical and echocardiographic indexes, which was developed and validated in different studies as prognostic tool in acute heart failure (HF) patients for the prediction of 30-days, 6-months and 5-years mortality after discharge. However, in these critical patients the prediction of in-hospital mortality may be fundamental to guide therapeutic management during hospital stay.

Objective
The aim of our study was to assess the prognostic value of ACUTE HF score for in-hospital mortality in an external cohort of patients hospitalized for acute HF.

Methods
Consecutive patients hospitalized for acute HF between 2020 and 2021 in our University Hospital were retrospectively enrolled. Patients with unclear diagnosis of de-novo, decompensated HF or HF reacutization were excluded. Clinical, biohumoral and echocardiographic data were collected. ACUTE HF score was calculated as : 1.4*[serum creatinine&gt;2mg/dl]+0.8*[ejection fraction&lt;30]+ 0.7*[age&gt;76]+0.7*[prior hospitalization for AHF]+0.9*[prior stroke/transient ischemic attack]+0.5*[more than moderate mitral regurgitation]+0.8*[use of non-invasive ventilation]. Then, it was used to divide the population into three risk groups (low risk: ACUTE HF ≤1.5; intermediate risk: 1.5

Results
Overall, 1291 patients were included in the present study (age=77±13 years, mean ejection fraction = 41 ± 13%). Median in-hospital follow up was 9 [6;15] days, during which 115 patients died. Patients who died during hospitalization were older, had worse renal function and higher mitral regurgitation severity, and more frequently had arterial hypertension, diabetes mellitus, chronic obstructive pulmonary disease and history of stroke. With ROC curves, it showed to be a good predictor of in-hospital mortality, with an AUC=0.66, which was even higher in patients with preserved ejection fraction (AUC=0.76, Fig.1). With multivariate analysis, ACUTE HF score showed to be a predictor of in-hospital mortality independent from arterial hypertension, diabetes mellitus, chronic kidney disease (OR = 1.5 [C.I. 1.22 – 1.81 each point increase]. Kaplan Meier analysis showed a good risk stratification of study cohort divided into 3 risk groups according to ACUTE HF (Fig.2)

Conclusions
ACUTE HF score is an independent and reliable predictor of in-hospital mortality in patients hospitalized for acute HF. After multiple external validation, considering its rapid and easy calculation, we suggest its use in the management algorithms of acute HF patients in daily clinical practice.Fig.1Fig.2
Larger change in intra-thoracic impedance before and during heart failure hospitalization is associated with longer length of stay in patients with cardiovascular implanted electronic devices
Authors: Sarkar S , Koehler J 
Published: November 2023

Abstract

Background
Intra-thoracic impedance measured in implantable cardioverter defibrillators (ICD) and cardiac resynchronization therapy defibrillators (CRTD) is a measure of intravascular blood volume and have been shown to correlate with intracardiac pressures in previous studies.

Purpose
We investigated whether amount of change of intrathoracic impedance before admission is associated with length of stay (LOS) during heart failure (HF) hospitalizations in a large real-world cohort of patients with ICD/CRTD devices.

Methods
We linked a deidentified database of aggregated electronic health record during the period from 2007-2017 to a manufacturer’s device data warehouse with device based continuous diagnostic monitoring data. Patients with ICD/CRTD implants with intra-thoracic impedance measurements were included for this study. HF event was defined as an inpatient, emergency department, or observation unit stay in a hospital with primary diagnosis of HF and intravenous diuretics administration. Relative change of daily intra-thoracic impedance measurement from 60 days prior to admission and date of admission as well as from admission to discharge were compared in HF events with LOS &lt; 5 days and LOS ≥ 5 days using a Wilcoxon rank sum test.

Results
A total of 17,886 patients with 1.8±1.2 years of follow-up met inclusion criteria. The average age of patients was 66.6 ±12.3 years, with 72% being males, and 51% with ICD devices. The relative change in intra-thoracic impedance from 60 days prior till date of admission and from admission to discharge for HF events with LOS &lt; 5 days and LOS ≥ 5 days are shown in Table. A total of 1456 patients had 1720 HF events of which 874 events had LOS&lt; 5 days and 846 had LOS≥ 5 days. HF events with a longer length of stay (LOS ≥ 5 days) had a higher relative decrease in intra-thoracic impedance prior to admission compared to HF events with a shorter length of stay. HF events with a longer length of stay (LOS≥ 5 days) had a higher relative increase in intra-thoracic impedance during hospital stay.

Conclusions
In a large real-world population of patients with ICD/CRTD devices, longer length of stay is more likely in patients with a larger relative decrease in intra-thoracic impedance prior to admission, indicating more accumulated fluid. Further, larger relative increase in intra-thoracic impedance during hospital stay was observed in patients with longer length of stay, indicating more fluid removal.
Disproportionate MR and 5-year mortality following acute heart failure hospitalisation
Authors: Berrill M , Beeton I , Fluck D , John I , Baltabaeva A 
Published: November 2023

Abstract

Background
The clinical implications of disproportionate mitral regurgitation (DispMR) is contentious and uncertainty remains if this cohort of patients benefit from intervention. Its prognostic significance in acute heart failure remains incompletely investigated.

Purpose
To examine whether DispMR, defined by the ratio of the effective regurgitant orifice area (ERO)/LVEDV &gt;0.14mm2/ml, is an independent predictor of long-term mortality following hospitalisation for AHF.

Methods
418 consecutive AHF patients were recruited and followed up for the primary outcome of all-cause, 5-year mortality. A key secondary outcome was cardiovascular (CV) death. Patients were recruited if they displayed signs and symptoms of AHF, had point-of-care brain-natriuretic peptide &gt;100pg/ml and had evidence of AHF on comprehensive bedside transthoracic echocardiography. 30 variables encompassing age, gender, BMI, a history of COPD, CKD, hypertension, diabetes, previous CVA, CAD, AF on admission ECG, admission systolic BP, NYHA classification, heart rate, Na, BNP, urea, anaemia, LA size, RA size, TR severity, lateral E/e’ &gt;14, RV diastolic area, TAPSE, SPAP, LVEF phenotype, a loop diuretic, MRA, beta-blocker, ARB/ACE-I, CCB or statin prescribed on discharge were included. Multivariate Cox-proportional hazard models were constructed to test for an independent prognostic role of DispMR. Missing outcome data was right-censored.

Results
313/418 (74.8%) displayed secondary MR and had quantifiable ERO and LVEDV (median age 81, 53.4% male) and were included in analysis. 217/313 (66.5%) displayed DispMR. Kaplan-Meier curve analysis revealed worse all-cause mortality in DispMR vs. proportionate MR (HR 1.72 95% CI 1.31-2.27 [p&lt;0.001]). On multivariable analysis DispMR was independently associated with all-cause mortality (HR 1.77 (95% CI 1.26-2.51 [p=0.0012]). 284/313 (90.7%) had CV mortality data available. DispMR was associated with increased risk of 5-year, unadjusted, CV mortality compared to proportionate MR (HR 1.72 95% CI 1.31-2.27 [p&lt;0.001]). These effects were present across all ejection fraction phenotypes.

Conclusions
Among patients with quantifiable MR in AHF, the presence of DispMR was independently associated with long-term outcome. These results suggest assessment of MR within the context of LV volumes can identify patients at increased risk and should have implications for future guidelines.
The HFA PEFF diagnostic algorithm poorly correlates with invasive LV filling pressure in HF PEF
Authors: Bauer F , Berthelot E , Gueffet J P , Damy T , Eicher J C , Logeart D , Fauvel C , Trochu J N , Habib G , Isnard R , Degroote P , Lamblin N 
Published: November 2023

Abstract

Background
Heart failure with preserved ejection fraction (HFPEF) patients typically have elevated LV filling pressures, whether at rest and/or on exercise. In 2020, the HFA-ESC proposed a process to detect HFPEF called HFA–PEFF diagnostic algorithm, which has not been validated against invasive right heart catheterization (RHC).

Purpose
The purpose of this work was to compare this algorithm against LV filling pressures invasively calculated.

Methods
PH-HF registry enrolled 663 patients with HF from which 276 had preserved ejection fraction with and without pulmonary hypertension explored at 11 French centres between 2011 and 2021. Patients meeting the 2021 ESC definition of heart failure underwent both RHC at steady state under optimal medical therapy and a complete ultrasound study within 24 hours. From 4 domains, the HFA–PEFF score was calculated with the use of major and minor criteria. A score ≥5 points is considered to be diagnostic, while between 2-4, further investigations are requested. The score was compared to pulmonary wedge pressure.

Results
Mean age age was 69,5±12.4 years, 35,1% male, mean left ventricular ejection fraction was 62,5±7,2%. Wedge pressure was 20,5±7,5 mm Hg and HFA-PEFF score averaged 4,9±1,2 with 181 patients (66%) above 5. Sensitivity and specificity were 68% and 46%, respectively. The figure 1 demonstrates the misclassification of patients, particularly those with high HFA-PEFF score but normal left ventricular filling pressure (lower right), that are badly categorized.

Conclusions
The HFA-PEFF score poorly correlates with invasive measurement of LV filling pressure. Patients with high score may require more careful attention as they are often misclassified.Figure 1
Reduced systolic flow efficacy in left ventricular dyssynchrony evident by blood speckle imaging
Authors: Witso M , Hammersboen L E , Frostlid V C , Fadnes S , Sletten O J , Lovstakken L , Odland H H , Remme E W , Stugaard M , Skulstad H 
Published: November 2023

Abstract

Introduction
Intraventricular vortices facilitate efficient blood flow in a healthy heart. Changes in the blood flow pattern can cause energy loss and inefficient filling or ejection. Thus changes, or reduction in vorticity may therefore be of importance for cardiac function. Blood speckle imaging (BSI) is a novel blood flow visualization tool based on echocardiography, partially overcoming the angel dependency of conventional colour Doppler. BSI tracks speckles generated by the moving blood cells, similar to myocardial speckle tracking, but requires a very high frame rate limiting penetration. Dyssynchrony in left bundle branch block (LBBB) affects the systolic functions but there is limited insight into how LBBB alters the blood flow vorticity.

Purpose
We investigated the effect of dyssynchrony on blood flow hemodynamics using blood speckle imaging.

Methods
In eight anesthetized canine mongrels, left ventricular flow was visualized using BSI. A qualitative visual assessment of vortices during the cardiac cycle, together with a quantitative assessment based on kinetic energy loss and vorticity were made. Regional myocardial function parameters were measured by sonomicrometry. Peak septal flash strain in isovolumetric contraction (IVC) was measured by sonomicrometry (figure) as an indicator of dyssynchrony. Assessments were made at baseline, under right ventricular free wall pacing (RV pacing) mimicking LBBB, after induced LBBB by ablation and under cardiac resynchronization therapy (CRT).

Results
During IVC at baseline all animals had a central ventricular vortex. However during RV pacing and LBBB it was distorted in various patterns. RV pacing significantly reduced the number of vortices in systole and disrupted the central vortex in IVC (1.0±0.0 vs 0.4±0.5, p=0.01). Energy loss (EL) in systole increased (40.2±12.5 vs 55.3±23.3 mW/m, p&lt;.05). Septal end systolic strain was significantly reduced (-8.8±5.1 vs -1.9±7.3 %, p&lt;0.01) and septal flash strain was significantly increased (1.0±1.4 vs 7.7±3.6 and 6.6±3.8 [ER1] [ER2] %, p&lt;0.01) in RV pacing and LBBB. CRT caused a realignment of the central vortex (0.8±0.5 vs0.3±0.5, p=0.03). The change in energy loss was not significant, but numerically reduced (55.4±38.8 vs 76.4±48.9 mW/m, p=0.06). See table and figure 1.

Conclusions
The main systolic vortex in IVC was disrupted during septal flash by RV pacing and LBBB, altering the flow pattern compared to baseline. The resultant unstructured flow pattern had increased energy loss in systole, indicating a less efficient flow pattern and less preservation of energy. It should be further explored if this is of importance to understand the reduced LV function and LV remodelling during dyssynchrony.Figure 1Table 1
Prognostic implications of right ventricular systolic and diastolic strain in heart failure
Authors: Matshela M R 
Published: November 2023

Abstract

Background
2D- speckle-tracking echocardiography (2D-STE) has recently be used to assess subclinical myocardial dysfunction, however its utility in heart failure with reduced ejection fraction (HFrEF) has been specifically focusing on the longitudinal systolic function of the left ventricle (LV).

Aim
To assess the prognostic relation between right ventricular (RV) systolic and diastolic strain parameters with clinical outcome in patients with advanced heart failure (HFrEF).

Methods and results
Of the initial 2217 HFrEF patients screened for this study only 562 consecutive patients with HFrEF were eligible and retrospectively enrolled, and 2D-STE strain parameters assessed on the 2D-TTE images. All patients were prospectively followed for development of new outcome/cardiac events which included hospitalization for acute HF, CVS-related death, heart transplantation, or need for ventricular assist device implantation.
Conventional TTE was performed in all subjects and reviewed. RV longitudinal strain parameters (RVLS, RVLD) by 2D-STE were assessed and averaged in all segments (apical 4CV, global RVLS and RVLD) and also averaged free-wall.
Of the 562 patients at baseline, 263 had 117 new events during a mean follow-up of 1.4 ± 0.7 years. RV free wall and global RV systolic and diastolic strain parameters, elevated NT Pro-BNP, RV fractional area change, low TAPSE, LV end-diastolic volume and the presence of at least moderate TR, and PASP &gt; 40mmHg were independently predictive of combined outcomes ( p &lt;.001).
Overall, the best performance parameters predictive of cardiovascular events were for RV Free Wall systolic and diastolic strain (AUC: 0.84 and 74), global RV systolic and diastolic strain (AUC: 0.77 and 70) and RV fractional area change (AUC: 0.67). The strongest association between the degree of RV dysfunction and the risk of cardiovascular events was only evident for RV strain (free wall &gt; global strain).

Conclusion
Patients with HFrEF, RV strain parameters are stronger predictors of outcome than other conventional parameters and should be included for regular clinical screening as these parameters provide a stronger prognostic stratification.
Prognostically optimal heart rate at discharge in hospitalized patients with heart failure and atrial fibrillation
Authors: Kishihara M , Jujo K , Kawakami R , Fukushima N , Takada T , Abe T , Shirotani S , Yoshida A , Hata T , Watanabe S , Kawamoto T , Hasegawa S , Yamaguchi J 
Published: November 2023

Abstract

Background
The management of heart rate (HR) is crucial for improving the clinical prognosis of patients with heart failure (HF) and atrial fibrillation (AF). Tachycardia induced by AF can cause decompensation of HF and subsequent hospitalization, but guidelines do not mention a specific target HR for patients with HF and persistent AF. Indeed, the prognostic impact of HR at discharge for hospitalized patients with HF and AF is still unclear.

Purpose
The purpose of this study was to determine the optimal HR at discharge for improving the prognosis of hospitalized patients with HF and AF.

Methods
In this observational study, 334 patients with persistent AF were analyzed from a database of 1,930 consecutive patients hospitalized for HF. Patients with sinus rhythm or paroxysmal AF, those with cardiac pacemakers or other antiarrhythmic devices, and those whose HR was not recorded at discharge were excluded. Participants were divided into 4 groups based on HR at discharge, with every 10 beats per minute (bpm) increment: HR &lt;60 bpm (N=79), 61 bpm &lt; HR &lt;70 bpm (N=89), 71 bpm &lt; HR &lt;80 bpm (N=101), and 81 bpm &lt; HR (N=65). The association between HR at discharge and the incidence of composite death from any cause and rehospitalization due to HF was analyzed as the primary endpoint.

Results
The average age of participants was 78 years, and 60% were men. At discharge, the clinical profiles of patients in the 4 groups were comparable. During the median follow-up period of 356 days, the primary endpoint occurred in 133 patients (39.8%). Kaplan-Meier analysis showed a significantly higher incidence of the primary endpoint in patients with HR &gt;81 bpm at discharge than in those with HR &lt;60 bpm at discharge (log-rank test for trend: p=0.039, Figure A). After adjusting for diverse covariates, including the use of beta-blockers, multivariable Cox regression analysis revealed that HR &gt;81 bpm at discharge was associated with the primary endpoint, with a hazard ratio of 1.75 (95% confidence interval: 1.03–2.98) compared to HR &lt;60 bpm. Restricted cubic spline confirmed that HR &gt;81 bpm at discharge was an independent predictor for the primary endpoint by a referred HR of 61 bpm (Figure B).

Conclusions
This observational study suggests that for better clinical outcomes, the HR at discharge for patients with HF and persistent AF should be controlled to less than 80 bpm.Figure AFigure B
Outcome of transcatheter mitral valve repair in heart failure patients with reduced ejection fraction and severe left ventricular dilatation
Authors: Sone M , Suzuki A , Kikuchi N , Yoshikawa M , Minami Y , Inagaki Y , Nakao M , Domoto S , Arashi H , Arai K , Shiga T , Ashihara K , Niinami H , Yamaguchi J 
Published: November 2023

Abstract

Introduction
The COAPT trial demonstrated the benefit of transcatheter edge­to­edge mitral valve repair (TEER) for heart failure patients who had reduced ejection fraction (HFrEF) with symptomatic secondary mitral regurgitation (MR). However, patients with severe left ventricular (LV) dilatation were not included in the COAPT trial. Furthermore, disproportionate LV dilatation was suggested as a possible explanation for the lack of benefit in the MITRA­FR trial.

Purpose
The purpose of this study was to assess the safety and efficacy of TEER in HFrEF patients with severe LV dilatation.

Methods
We studied 75 HFrEF patients who underwent mitral valve repair between 2018-2021. Reduced LV ejection fraction (LVEF) was defined as LVEF of 40% or less. These patients were categorized with and without severe LV dilatation based on left ventricular end-diastolic volume index (LVEDVI) using a median cut­off value of &gt;139ml/m2 in men and &gt;128cm/m2 in women.

Results
There were 37 patients with severe LV dilatation (D) and 38 without (ND). Median LVEDVI was 172 [149-190] ml/m2 in the D group vs 120 [105-127] ml/m2 in the ND group. Compared to the ND patients, patients with severe LV dilatation were more treated with SGLT2-inhibitor (rate 24% vs 3%), had lower LVEF (30 [25-31] % vs 32 [30-36] %), and higher BNP (1160 [683-2586] vs 619 [396-1253] pg/ml). There was no significant difference in MR grade (4 [3-4] vs 4 [3-4]), EROA (0.32 [0.22-0.66] vs 0.34 [0.24-0.48] cm2), NYHA class (3 [2-4] vs 3 [2-3]) and mean systolic pulmonary pressure (31 [20-43] vs 34 [25-41] mmHg). Peri­procedural adverse events were rare in both groups. 1 patient had pseudoaneurysm in the ND group, and 1 patient had cardiogenic shock and 1 patient had stroke after the procedure in the D group. At discharge, there was marked improvement in MR grade (1 [1-2] vs 1 [1-2] for both). D group had a tendency of higher reduction in LVEDVI (-12 [-24--1] vs -5[-13-4] ml/m2) than ND group. BNP level of the D group had a significantly higher degree of decline before discharge (-458 [-141--1566] to -102 [+51--306] pg/ml) than that of ND group. No differences were noted in mortality between two groups (Figure).

Conclusion
TEER in HFrEF patients with severe LV dilatation seems to provide similar outcomes compared to patients with less severe dilatation. Further studies are needed to clarify the indication and establish the effectiveness of TEER in these patients.
Cardiac resynchronosation and left ventricular ejection fraction improvement with single ventricular conduction pacing system lead
Authors: Ayala Valani F G , Ayala Valani L M , Ayala Paredes F 
Published: November 2023

Abstract

Background
Conduction system pacing is a new modality to obtain physiologic pacing (PP) and normal to near normal cardiac synchrony; they often obtain shorter QRS durations and they could replace the need of Bi-V (CRT) implants if LVEF improves as much with less leads implanted.

Methods
From our cohort of 340 physiologic pacing attempts (2019-2023), we extracted all patients (pts) with available ultrasounds before and after implants, aiming to describe the variation of Left Ventricular Ejection Fraction (LVEF) over time; all attempts, including failures were analyzed.

Results
A total of 146 pts completed follow-up LVEF evaluation. Pts were 36,8% females; median age was 79 +/- 8.5 years. Indications were: SSS 25%, AV block 41% (including 11 post TAVR), Pacemaker induced cardiomyopathy (PIMC) 27% and AV node ablation in 7%. Success to achieve cardiac resynchronisation (defined as a QRS shorter than 140ms and a LVAT shorter than 90ms, or 20% reduction in QRS width) was obtained in 82,6% of pts (higher success rate achieved with LBB-P: 88,4% vs 55,5% for His-P). Procedural time (pts in-out) was 88min (+/- 37min). Pts with a QRS larger than 150ms (CRT indication) were 49% of the cohort. Patients with a LVEF less than 50% accounted for 54,8% of the cohort. Mean QRS duration was 141,9ms (+/-36) pre-implant and 129,3ms (+/- 19) post implant. Mean LVEF was 43,6% (+/- 14) before implant and increased to 50,2% (+/-12) post implant for the entire cohort, in pts with CRT indication, variation persisted: mean LVEF improved from 33,2 to 43,8% and QRS duration from 172,9 to 136,8ms. Pts with less than 50% LVEF had a response rate of 75,5% (increase in LVEF from 4-41%), and 33% of patients increase their LEVF between 10-30% (deemed super responders), only one pt decrease 10% her LVEF (a His failure implant).

Conclusion
Cardiac resynchronisation is feasible with only one ventricular lead, potentially with longer duration of batteries and lesser costs. Response rate is similar to CRT historical controls but super responders are twice to three times higher than historical controls.