bluuebunny/crossref_metadata_2025_split huggingface dataset:
Speckle-tracking global longitudinal strain as a predictor of clinical outcomes in patients with idiopathic inflammatory myopathies
Authors: Stronati G , Paolini F , Brugiatelli L , Alfieri M , Bastianoni G , Palmieri D , Paladini A , Dello Russo A , Moroncini G , Danieli M , Guerra F 
Published: November 2023

Abstract

Background
Idiopathic inflammatory myopathies (IIM) are systemic immune-mediated diseases that involve the skeletal muscle and several other organ systems, including the heart. Nonetheless, cardiac involvement in IIM is frequent and initially subclinical. Previous studies have demonstrated how speckle-tracking-derived global longitudinal strain (GLS), as a measurement of the subclinical systolic ventricular dysfunction, is significantly lower in IIM compared to healthy controls.

Purpose
To assess the progression of myocardial deformation in patients with IIM and test GLS as a prognostic marker of death and cardiovascular events.

Methods
We enrolled all consecutive patients with a diagnosis of IIM sent to our Cardiology Clinic. The diagnosis of definite idiopathic polymyositis or idiopathic dermatomyositis as made according to the Bohan and Peter criteria and confirmed by muscle biopsy. Patients with inclusion body myositis, necrotizing autoimmune myositis, overlap myositis, and juvenile myositis were excluded from our study. All patients underwent full evaluation, including clinical, ecg and echocardiographic assessment as well as GLS calculation both at baseline and follow up appointments. Primary endpoint was a composite of death and cardiovascular events.

Results
41 consecutive patients (28 females, 58±15 years) with IIM were consecutively enrolled and followed up for a median of 8 years (4-11 years). During follow-up, a progressive worsening of LVEF (-4%; p=.03) and left GLS (LGLS: +3%; p=.04) was shown, along with an increase in atrial volumes (iLAV: +8 cm2/m2; p=.02; iRAV: +10 cm2/m2; p=0.01) and estimated filling pressures (E/e': +2; p=.01).
A left GLS (LGLS) &gt; -16% predicted the composite endpoint with a sensitivity of 80% and a specificity of 67% (AUC 0.74). Estimated survival from the composite endpoint was 85% for the normal LGLS group and 35% for the impaired LGLS group (Figure 1). Right GLS was not significantly associated with the primary endpoint.

Conclusions
Heart involvement is becoming a major cause of death in patients with myositis. Data reported that subclinical heart involvement, characterized by biochemical and instrumental modifications, is estimated to affect around 70% of patients with myositis. Cardiac involvement in IIM is often subclinical in the early stages of the disease. GLS has been proven to be an effective tool to predict heart disease. Our results show that GLS worsens over time and can be used as a possible predictor of death and cardiovascular events in this population.Figure 1
Organ perfusion pressure at admission and clinical outcomes in patients hospitalized for acute heart failure
Authors: Bocchino P P , Cingolani M , Frea S , Angelini F , Gallone G , Garatti L , Sacco A , Raineri C , Pidello S , Morici N , De Ferrari G M 
Published: November 2023

Abstract

Background
Hypoperfusion portends adverse outcomes in acute heart failure (AHF). The gradient between end-organ inflow and outflow pressures may more closely reflect hypoperfusion than mean arterial pressure (MAP) alone.

Purpose
To investigate organ perfusion pressure (OPP), calculated as MAP minus central venous pressure (CVP), as a prognostic marker in AHF.

Methods
The SNIP-AHF study was a multicenter retrospective cohort study of 200 consecutive patients hospitalized for AHF treated with sodium nitroprusside. Only patients with both MAP and invasive CVP data available from the SNIP-AHF cohort were included. The primary endpoint was to assess OPP as a predictor of worsening heart failure (WHF) at 48 hours.

Results
146 patients were included (mean age: 61.1±13.5 years, 32 [21.9%] females; mean left ventricular ejection fraction: 23.8%±11.4%, mean MAP: 80.2±13.2 mmHg, mean CVP: 14.0±6.1 mmHg). WHF occurred in 14 (9.6%) patients. At multivariable models including hemodynamic variables (OPP, shock index, MAP and CVP), OPP at admission was the best predictor of WHF at 48 hours (OR 0.91 [95%CI 0.86-0.96], p-value = 0.001) with an optimal cut-off value of 67.5 mmHg (specificity 47.3%, sensitivity 100%, AUC 0.784±0.054 [p-value&lt;0.001]). In a multivariable model including univariable significant parameters available at first beside assessment, namely New York Heart Association functional class, OPP, shock index, MAP and left ventricular end-diastolic diameter, OPP significantly predicted WHF at 48 hours (OR 0.82 [95%CI 0.68-0.98], p-value=0.027).

Conclusion
In this retrospective analysis on patients hospitalized for AHF treated with sodium nitroprusside, on-admission OPP significantly predicted WHF at 48 hours with high sensitivity.OPP in acute heart failureMultivariable analysis on WHF
The effect of intra-aortic balloon pumping on hemodynamics and left ventricular load in Impella-supported condition: A simulation study
Authors: Matsushita H , Yokota S Y , Kakuuchi M K , Yokoi A Y , Nishiura A N , Yoshida Y Y , Uemura K U , Kawada T K , Unoki T U , Nishikawa T N , Saku K S 
Published: November 2023

Abstract

Introduction
Intra-aortic balloon pumping (IABP) is a commonly used percutaneous mechanical circulatory support device. Although IABP combined with Impella, a percutaneous left ventricular assist device, has shown positive outcomes in a few case reports of acute heart failure, its hemodynamic and left ventricular (LV) unloading effects remain unclear.

Purpose
We conducted a simulation study to clarify the clinical benefits of adding IABP to Impella-supported conditions.

Methods
We used SimulinkⓇ for cardiovascular simulation. The systemic and pulmonary circulation were modelled by using a 5-element resistance-capacitance network with four ventricles represented by time-varying elastance and unidirectional valves (Figure 1A). We compared total systemic flow, coronary perfusion pressure (CPP), and pressure-volume relationships (PV loop) in severe LV dysfunction (LV end-systolic elastance: 0.2 mmHg/mL) under three scenarios: IABP with a 40 mL balloon volume added to baseline, IABP added to Impella CP support at P2 (partial support) and P8 (total support) (Figure 1B).

Results
As shown in Figure 2A, IABP increased total systemic flow and CPP, and shifted the PV loop to the left. In P2-Impella condition, the addition of IABP increased native cardiac output (0.3 to 0.7 L/min) and total systemic flow (2.7 to 2.9 L/min), while decreased Impella pump flow due to increased afterload of Impella during diastole. IABP further moved PV loop leftward and reduced LV pressure-volume area (PVA) by -3.8% from Impella only and -7.8% from baseline (Figure 2B). In P8-Impella condition, IABP did not change total systemic flow, CPP, or PV loop (Figure 2C).

Conclusions
The addition of IABP to Impella could increase CPP while increasing Impella pump afterload and decreasing Impella flow. Overall, IABP slightly increased total systemic flow and decreased LV workload in Impella partial support condition. In specific clinical situations, IABP has the potential to be used as adjuvant therapy alongside Impella partial support.Figure 1
Association between sex and efficacy of intravenous ferric carboxymaltose in patients with acute heart failure and iron deficiency: an AFFIRM-AHF subgroup analysis
Authors: Rosano G , Roubert B 
Published: November 2023

Abstract

Background/Introduction
Heart failure (HF) pathophysiology, clinical presentation and treatment response is known to differ between males and females (1). In the AFFIRM-AHF trial, intravenous (IV) ferric carboxymaltose (FCM) reduced the risk of HF hospitalisations and improved quality of life vs placebo in patients with iron deficiency who had stabilised following an acute HF (AHF) episode (2,3); the effect of sex on outcomes with iron-repletion therapy in these high-risk patients has not been fully explored.

Purpose
To investigate the interaction between sex and the effects of FCM vs placebo on clinical outcomes in the AFFIRM-AHF population.

Methods
In AFFIRM-AHF, patients with left ventricular ejection fraction &lt;50% and iron deficiency (defined as serum ferritin &lt;100 ng/mL, or 100–299 ng/mL if transferrin saturation is &lt;20%) who had stabilised following recent hospitalisation for AHF were randomised 1:1 to receive IV FCM or placebo for up to 24 weeks.2 The primary endpoint was a composite of total HF hospitalisations and cardiovascular (CV) death up to Week 52; secondary endpoints are listed in the Figure.2 In this prespecified analysis, AFFIRM-AHF patients were stratified into male and female subgroups and the interaction between sex and clinical outcomes with FCM vs placebo was explored.

Results
Of the 1108 patients included in the AFFIRM-AHF full analysis set, 614 (FCM: 314; placebo: 300) were male and 494 (FCM: 244; placebo: 250) were female. At baseline, a New York Heart Association functional class of III and above was more common in females (59.0%) than in males (48.4%). For the primary endpoint, the adjusted annualised event rate per 100 patient-years with FCM vs placebo was 53.3 vs 83.3 in males (rate ratio [RR] 0.64; 95% confidence interval [CI] 0.46–0.89) and 63.1 vs 60.3 in females (RR 1.05; 95% CI 0.72–1.53) (Figure). For all secondary endpoints except time to CV death, effect sizes in male and female subgroups were similar to those for the primary endpoint. The interaction between sex and treatment effect was non-significant for the primary endpoint (P-interaction=0.054) but reached significance for the secondary endpoints of total CV hospitalisations and CV death (P-interaction=0.024) and time to first HF hospitalisation or CV death (P-interaction=0.043).

Conclusion(s)
The results of this exploratory subgroup analysis suggest that iron deficiency treatment with IV FCM following an AHF episode may be more effective in males than in females; this may be related to baseline differences between sex subgroups, beyond the factors adjusted for in this analysis.Figure
Deep night: critical periods for the onset of acute myocardial infarction in obstructive sleep apnea patients
Authors: Zhang R U I Y A N , Quan W E I W E I , Wang Y 
Published: November 2023

Abstract

Introduction
Obstructive sleep apnea (OSA) is associated with acute nocturnal hemodynamic and neurohormonal abnormalities that may increase the risk of coronary events, especially during deep sleeping time. This study sought to investigate the circadian variation of onset of acute myocardial infarction (AMI) in OSA patients and its long-term prognosis.

Purpose
In this study, we tested the hypothesis that people with OSA are more likely to have AMI during deep sleeping time than the other six-hour intervals of the day. Additionally, we assess the impact of circadian symptom-onset patterns of AMI on prognosis in OSA patients.

Methods
We prospectively enrolled 397 patients with AMI, for which the time of onset of chest pain was clearly identified. All subjects were categorized into non-OSA (n = 280) and OSA (n = 117) groups. The association between AMI onset time and major adverse cardiovascular and cerebrovascular events (MACCEs) was estimated by Cox proportional hazards regression.

Results
AMI onset occurred from midnight to 6 a.m. in 33% of OSA patients, as compared with 15% in non-OSA patients (P &lt; 0.01). For OSA people, the relative risk of AMI from midnight to 6 a.m. was 1.990 (95% CI 1.329-2.929) compared with non-OSA patients (Figure 1). After a median of 2.89 ± 0.78 years follow-up, symptom onset time was significantly associated with risks of MACCEs in OSA patients, but not in non-OSA patients. The hazard ratios (HRs) for OSA patients were 4.683 (95% CI 2.024 to 21.409) for midnight to 6 a.m., and 6.964 (95% CI 1.379 to 35.169) for 6 p.m. to midnight as compared with AMI presenting during noon to 6 p.m (Figure 2).

Conclusion
Patients with OSA showed a peak incidence of AMI during the deep night, which was independently associated with adverse events.Figure 1Figure 2
One-year outcomes in cardiogenic shock triggered by supraventricular tachycardia: an analysis of the FRENSHOCK multicenter prospective registry
Authors: Cherbi M , Bonnefoy E , Lamblin N , Gerbaud E , Bonello L , Roubille F , Levy B , Labbe V , Marchandot B , Lattuca B , Biendel-Picquet C , Leurent G , Puymirat E , Maury P , Delmas C 
Published: November 2023

Abstract

Background
Cardiogenic shock (CS) is the most severe form of heart failure (HF), resulting in high early and long-term mortality. Characteristics of CS secondary to supraventricular tachycardia (SVT) are poorly reported. Based on a large registry of unselected CS, our aim was to compare one-year outcomes between SVT-triggered and non-SVT-triggered CS.

Methods
FRENSHOCK is a prospective registry including 772 CS from 49 centers. One to three triggers could be identified (ischemic, mechanical complications, ventricular/supraventricular arrhythmia, bradycardia, iatrogenesis, infection, non-compliance, others). One-year outcomes (rehospitalizations, mortality, heart transplantation (HTx), ventricular assist devices (VAD)) were analyzed, adjusted on independent predictive factors.

Results
Within 769 CS included, 100 were SVT-triggered (13%) with 65 with SVT as exclusive trigger (8.5%). SVT triggered CS patients were more male with more frequent history of cardiomyopathy or chronic kidney disease, and more profound CS (biventricular failure and multiorgan failure). At 1-year, there was no difference in all-cause mortality (HR 0.91 [0.66 – 1.26], p = 0.58), need for HTx or VAD (OR 0.88 [0.41 – 1.88], p = 0.74) or rehospitalizations (OR 1.24 [0.78 – 1.98], p = 0.36). Patients with SVT as exclusive trigger presented more 1-year rehospitalizations (OR 3.74 [1.05 – 10.5], p = 0.01).

Conclusion
SVT is a frequent trigger of CS alone or in association in more than 10% of miscellaneous CS. Although SVT-triggered CS patients were more comorbid with more pre-existing cardiomyopathies and HF, they presented similar rates of mortality, HTx and VAD at 1-year arguing for a better overall prognosis.Graphical abstract
Incidence of hypoxic hepatitis in patients with cardiogenic shock and association with mortality
Authors: Beer B N , Besch L , Weimann J , Surendra K , Sundermeyer J , Dettling A , Kluge S , Kirchhof P , Blankenberg S , Roedl K , Schrage B 
Published: November 2023

Abstract

Background
Shock of any cause leads to hypoxic and toxic organ damage, especially in perfusion-sensitive organs such as the liver. In septic shock, hypoxic hepatitis is defined as an increase of ASAT and ALAT to &gt;700 U/l and is associated with increased mortality. However, pathophysiology, dynamics and treatment differ between septic and cardiogenic shock (CS). Thus, the definition of hypoxic hepatitis derived from patients with septic shock may not be suitable in CS.

Purpose
To evaluate incidence and impact of hypoxic hepatitis in patients with CS based on existing as well as on novel CS-specific cut-offs.

Methods
Unselected patients &gt;18 years treated for cardiogenic shock at a tertiary care centre between 2009 and 2019 were analysed for presence and prognostic impact of hypoxic hepatitis. Receiver operating curve analyses/Youden Index Method were used to determine optimal ASAT/ALAT cut-off values for hypoxic hepatitis. Multivariable adjusted logistic regressions models were constructed to compare different ASAT/ALAT cut-offs for the prediction of in-hospital mortality.

Results
This analysis included 698 patients [mean age 69 years, 212 (29.9%) female]. A total of 386 (55.3%) patients died. Liver enzyme elevation &gt;700 U/l was present in 135 (19.1%) patients and not associated with in-hospital mortality (OR 1.1, 95% CI: 0.69, 1.75, p-value 0.69). Mortality was best predicted by new cut-offs with a &gt;34% increase for ASAT and a &gt;51% increase for ALAT. Using these criteria, hypoxic hepatitis was found in 36% (254/698 patients), most commonly during early disease trajectory (74% within first 3 days, Figure 1). Hypoxic hepatitis using this definition was associated with in-hospital mortality (OR 2.46, 95% CI: 1.67, 3.64, p-value &lt;0.001).

Conclusion
Using novel, CS-specific cut-offs, defines hypoxic hepatitis as a relevant marker of excess mortality in patients with CS. These findings identify hypoxic hepatitis as a relevant disease modifier in CS and emphasises the need for further investigation of therapies reducing its occurrence and impact.Figure 1
Risk of sepsis after extracorporeal cardiopulmonary resuscitation in patients with refractory cardiogenic shock from the RESCUE registry
Authors: Oh K , Bae D H , Kim M , Lee J H , Kim S M , Choi W G , Hwang K K , Kim D W , Cho M C , Yang J H , Gwon H C , Bae J W 
Published: November 2023

Abstract

Objectives
It is known that the incidence of sepsis is higher in patients receiving extracorporeal membranous oxygenation (ECMO). In particular, extracorporeal cardiopulmonary resuscitation (ECPR) is performed in emergency situations, which may increase the likelihood of non-aseptic management compared to routine procedures. So, we investigated the association of ECPR and incidence of sepsis in patients with refractory cardiogenic shock (CS).

Background
Pre- and post-ECPR sepsis are associated with increased mortality, and it is known that the occurrence of sepsis after ECPR is higher than in conventional cardiopulmonary resuscitation (CPR). However, it is not well known whether ECPR has a higher incidence of sepsis than ECMO insertion in non-CPR conditions.

Method
The SMART-RESCUE study is a multi-center, retrospective and prospective registry of patients that presented with CS. Between January 2014 and December 2018, 1,247 patients with CS were enrolled from 12 major centers in Korea. The incidence of sepsis was compared by dividing into two groups according to whether or not ECPR was performed. Patients with ECMO duration less than 48 hours were excluded.

Result
Total of 231 patients(mean age 59.46 years, men 67.70%, mead follow-up duration 136.5 days) were analyzed into ECPR group(n=95, 60.7 ± 13.0 years, men 75.8%) and non-ECPR group(n=136, 58.6 ± 15.5 years, men 65.4%) respectively.
ECPR group showed lower SBP, lower DBP, lower HR, more shock caused by ischemia, more smoking, lower LVEF, higher Hb, higher serum Na, lower AST, higher Peak troponin I, higher vasoactive inotropic score, higher ICMP portion.
After 1:1 propensity score matching corrected for height, SBP, DBP, Hb, initial pump flow, Na, ICMP, vasoactive inotropic score, difference remained in SBP, DBP, HR, cause of shock.
Sepsis incidence was 7.4%. The risk for sepsis incidence was not different between two groups(7.4% vs 6.3%, adjusted OR 1.18, 95% CI 0.38-3.65, p=0.774).

Conclusion
ECPR procedure does not increase sepsis compared to ECMO insertion not in CPR state in patients with cardiogenic shock.Adjusted Baseline CharacteristicsAdjusted Outcomes
Changes in cardiac electrical biomarker with hyperaemic stress: an experimental perspective
Authors: Chattopadhyay S , Adjei F , Kardos A 
Published: November 2023

Abstract

Background
"Cardiac electrical biomarker" (CEB) is a numerical index measured by the Vectraplex ECG (vECG) System with Vectraplex AMI software that measures changes in the cardiac electrical field vectors from dipolar to multipolar during myocardial ischemia. CEB performs well in detecting NSTEMI and STEMI against physician adjudicated diagnosis.

Purpose
To assess changes in CEB during adenosine stress induced ischaemia.

Method
Thirty-three patients, in the VECTRA-PCI trial, with normal surface ECG (sECG) had CEB measured before (CEB0), at maximal hyperaemia (CEBh)) and 1-(CEB1), 2-(CEB2) and 3-(CEB3) hours after standard fractional flow reserve (FFR) assessment using intravenous adenosine. vECGs were adjudicated for quality by 2 blinded observers. vECGs with artefacts and arrhythmias were discarded and CEBs from best traces were analysed. Forty-nine individuals with non-cardiac chest pain, without past medical history or risk factors for CAD, on no medications, normal ECGs, normal blood profile acted as controls. CEBs (median, IQR) were compared using appropriate tests.

Results
FFR was normal (&gt;/=0.80) (nFFR) in 25 and ischaemic (&lt;0.80) (iFFR) in 8 patients. CEB0 in nFFR and iFFR groups were similar to each other (p=0.785) (Fig 1) and to controls (30.0; IQR 17.0-44.0, vs nFFR: p=0.057, vs iFFR: p=0.241). Compared to CEB0, CEBh was higher in nFFR (p=0.014) (Fig 1A) and iFFR (p=0.016) groups (Fig 1B). CEBh in iFFR (126.0; 109.5-216.0) higher than nFFR (44.0; 27.8-104.8), (p=0.039). In nFFR group, CEB1, 2 and 3, though numerically lower, were statistically similar to CEBh and CEB0 (Fig 1A) suggesting quick recovery. In iFFR group CEB1 was similar to and CEB2 and 3 were lower than CEBh (Fig 1B) suggesting a slower recovery of CEB. Both CEBh and change from CEB0 to CEBh (δCEB0-h), but not CEB0, predicted ischaemic FFR with similar accuracy (p=0.570) (Fig 2). CEBh &gt;96 and δCEB0-h &gt;28 had similar sensitivity of 87.5% with specificity of 68% and 80% respectively.

Conclusion
Obstructive coronary atheroma is associated with higher CEB than non-obstructive atheroma under hyperaemic stress. Both CEBh and δCEB0-h accurately predict ischaemic FFR with higher specificity of δCEB0-h. This is the first study to measure CEB changes with hyperaemic stress in patients with coronary artery disease and could have potential for wider clinical application.
Figure 1. Changes in the CEB during and after hyperaemic stress in patients with normal (A) and ischaemic (B) FFR.
Figure 2. Area under the ROC curve to determine the diagnostic accuracy of pre-procedural CEB, hyperaemic CEB and change in CEB from baseline to hyperaemia in determining ischaemic FFR.Fig 1. Changes in CEB with stress.Fig 2. CEB for ischaemic FFR