bluuebunny/crossref_metadata_2025_split huggingface dataset:
Impact of Clostridioides difficile infection in heart failure hospitalizations: analysis from the national inpatient sample database
Authors: Badu I , Taha A , Duhan S , Blagoie J , Tarff A , Hussein S , Hussein M H , Khir F , Keisham B , Sandhyavenu H 
Published: November 2023

Abstract

Background
Congestive heart failure (CHF) patients are at greater risk of nosocomial infections such as Clostridioides difficile infection (CDI) due to higher comorbidities, readmission rates, and prolonged hospital stays. Further, hypovolemia and sympathetic drive may aggravate myocardial dysfunction due to demand mismatch and worsen clinical outcomes.

Purpose
To assess the impact of CDI in congestive heart failure (CHF) hospitalizations nationally in the US.

Methods
The National Inpatient Sample database from 2016 to 2019 was queried to identify patients with a primary diagnosis of CHF. Subsequently, the sample was stratified based on the presence of CDI as a secondary diagnosis. The adjusted odds ratios (aOR) of in-hospital outcomes were calculated using chi-square statistics in software STAT v.17.

Results
Of 1,270,414 weighted hospitalizations with CHF, 8275 were diagnosed with CDI (0.65%). On adjusted analysis, patients with CHF and CDI had significantly higher in-hospital mortality (aOR 3.58, 95% CI 3.28-4.51, p&lt;0.001), cardiac arrest (aOR 3.89, 95% CI 2.79-5.41, p&lt;0.001), AMI (aOR 1.37, 95% CI 1.08-, p=0.007), MCS (aOR 5.16, 95% CI 3.91-6.8, p&lt;0.001), stroke (aOR 1.85, 95% CI 1.09-3.14, p=0.022) and MACE (aOR 2.54, 95% CI 2.21-2.91, p&lt;0.001), (Figure 1). Additionally, HF patients with CDI are associated with longer lengths of stay (12±16 vs. 5±6 ) and adjusted total charge ($133,045±291,290 vs. $51,919±133,303) compared to HF patients without CDI (Table 1).

Conclusions
CDI in CHF hospitalizations have adverse in-hospital outcomes with higher rates of in-hospital mortality, AMI, stroke, and MACE. This highlights the importance of early detection and aggressive infection prevention strategies in this high-risk population.Figure 1Table 1
Prognostic implications of angiopoietin-2 in heart failure and the influence of empagliflozin: the EMPEROR program
Authors: Butler J 
Published: November 2023

Abstract

Background
Heart failure (HF) development and progression is associated with endothelial dysfunction, oxidative stress, and inflammation. The mechanisms involved in endothelial repair in HF are not fully understood. Emerging evidence suggests that angiopoietin-2 (Angpt2), a vascular destabilizing factor, may be related to outcome in HF.

Aim
To assess the association between Angpt2 and clinical outcomes in a pooled analysis of the EMPEROR-Reduced and EMPEROR-Preserved trials, and to evaluate if the response to empagliflozin therapy in HF is modulated by Angpt2 levels.

Methods and results
Angpt2 levels (ng/ml) were measured in serum samples from 1131 EMPEROR study participants by using Roche Cobas Elecsys assay, within biomarker research agreement between Boehringer Ingelheim and Roche Diagnostics International Ltd, at baseline, week 12 and week 52. Patients were divided into tertiles of baseline Angpt2 levels (&lt;2.58 ng/mL; ≥2.58 ng/mL &lt;4.71 ng/mL and ≥4.71 ng/mL). Patients in the highest tertile were more frequently white people, had a higher prevalence of New York Heart Association class III-IV symptoms, HF hospitalization within 12 months, obesity, diabetes, atrial fibrillation, elevated natriuretic peptides, worse renal function, and lower prevalence of coronary disease, compared to the lowest tertile (p&lt;0.05 for all). Higher tertile at baseline was associated with increased risk for adverse HF and kidney events (Table 1). Empagliflozin treatment was associated with reduction of the serum Angpt2 versus placebo at week 12 (adjusted gMean 0.872 [0.828-0.917], p&lt;0.0001) but not at week 52 (adjusted gMean ratio 0.946, [0.879-1.019], p=0.145). Empagliflozin significantly reduced the risk of hospitalization for HF and cardiovascular death particularly for patients with highest baseline Angpt2 levels (lowest tertile HR 1.21 [0.63-2.31]; middle tertile HR 0.65 [0.37-1.16]; highest tertile HR 0.64 [0.42-0.97], P-trend=0.139).

Conclusion
Higher Angpt2 levels at baseline were associated with more advanced HF and worse prognosis. Treatment with empagliflozin was associated with reduction of Angpt2 level at week 12. The benefit of empagliflozin on major HF events was consistent across baseline Angpt2 levels.Table 1
Low muscle strength as a predictor of incident pneumonia in older patients with heart failure: sub-analysis of fragile-hf
Authors: Yamaguchi K , Konishi M , Kagiyama N , Kasai T , Kamiya K , Saito H , Saito K , Maekawa E , Kitai T , Iwata K , Jujo K , Wada H , Momomura S , Hibi K , Matsue Y 
Published: November 2023

Abstract

Background
Patients with heart failure often develop pneumonia during the course of their illness, which leads to high mortality. A decrease in swallowing muscle strength due to aging or concomitant disease may be involved in the development of pneumonia in the elderly. We sought to investigate the association between low muscle strength and the incidence of pneumonia in older patients hospitalized for worsening HF.

Methods
We carried out a sub-analysis of FRAGILE-HF, a prospective multicenter study, including 1228 consecutive older (&gt;=65 years) hospitalized patients with HF (median age 81; 57.6% male; left ventricular ejection fraction (LVEF) 46±17%). The patients were followed-up for two years after discharge from the index hospitalization.

Results
A total of 87 patients (7.1%) developed pneumonia after discharge, with an incidence of 43 per 1,000 patient-years. The patients with incident pneumonia were more likely to be male and had lower body mass index than those without pneumonia. A total of 895 patients (72.9%) with low muscle strength, defined as handgrip strength &lt;28 kg for men and &lt;18 kg for women according to the international criteria, were more likely to develop pneumonia than those with normal muscle strength (p&lt;0.001 for log-rank: figure). Low muscle strength was a significant predictor of incident pneumonia after adjustment with age, sex, body mass index, LVEF, and history of chronic lung disease and cerebral infarction (adjusted hazard ratio with 95% confidence interval: 3.31 [1.68-6.53], p&lt;0.001). Furthermore, 43.7% and 19.1% died in patients with and without pneumonia during the follow-up period, respectively, with the subsequent risk of all-cause mortality after the occurrence of pneumonia (adjusted hazard ratio: 4.09 [2.85-5.87], p&lt;0.001).

Conclusions
Low muscle strength was associated with incident pneumonia in older patients hospitalized for worsening HF. This finding may support the need for an interventional study targeting muscle wasting to prevent pneumonia in HF.
Atrial fibrillation as a trigger for acute heart failure
Authors: Halhal B , Bar O , Aronson D 
Published: November 2023

Abstract

Background
Both atrial fibrillation (AF) and heart failure (HF) facilitate the occurrence and aggravate the prognosis of each other, and often coexist (1). Rapid AF is considered to be a trigger for HF decompensation. However, rapid AF can also be secondary to the increase sympathetic drive associated with HF decompensation. Few data are available regarding the hemodynamic and metabolic consequences of rapid AF in acute HF.

Purpose
To study the clinical impact of rapid AF in acute HF.

Methods
We studied 8,997 patients admitted with acutely decompensated heart failure (ADHF). Propensity-score matching was generated using 21 clinical variables. The primary endpoint was in-hospital mortality.

Results
Rapid AF (defined as ventricular rate ≥110) at admission was present in 339 patients (3.8%). Patient with rapid AF had higher prevalence of diabetes, ischemic heart disease chronic lung disease, and higher levels of BUN and white blood cells (All P&lt;0.001). Systolic blood pressure was lower and diastolic blood pressure was higher with rapid AF (Table). Blood lactate levels were slightly higher with rapid AF but the O2 saturation, pH, bicarbonate and pCO2 levels were similar (Table). In a multivariable logistic regression model, adjusting for all available clinical variables, the odds ration (OR) for in hospital mortality was 1.07 (95% CI 0.77 to 1.49; P=0.69). Propensity score matching yielded 338 patient pairs. In-hospital mortality occurred in 16.3% of patients with rapid AF and in 12.7% of patients without rapid AF ( OR 1.34; 95% CI 0.87 to 2.08, P= 0.19).

Conclusion
Rapid AF at admission was not associated with a significant hemodynamic or metabolic compromise and carried a similar risk for in-hospital mortality as in patients without rapid AF.Hemodynamic and metabolic parameters
Predicting heart failure readmission and all-cause mortality in patients with acute heart failure: a simple predischarge risk score
Authors: Espersen C , Campbell R , Claggett B , Lewis E , Docherty K , Lee M , Lindner M , Brainin P , Biering-Soerensen T , Solomon S , McMurray J , Platz E 
Published: November 2023

Abstract

Introduction
Predischarge risk stratification of patients hospitalized for acute heart failure (AHF) could facilitate tailored treatment and follow-up, however, simple scores to predict short-term risk for HF readmission or death are lacking.

Purpose
We sought to develop a congestion-focused risk score to predict HF readmission and all-cause mortality after discharge in patients hospitalized for AHF.

Methods
We used data from a prospective, two-center observational study in adults hospitalized for AHF. Laboratory data were collected on admission. Patients underwent a physical examination, 4-zone, and in a subset 8-zone, lung ultrasound (LUS), and conventional echocardiography at baseline (within a median of 1 day after admission). A second LUS was performed before discharge in a subset of patients. The primary endpoint was the composite of HF rehospitalization or all-cause death. HF hospitalizations were adjudicated blinded to LUS findings.

Results
Among 297 patients with complete data (median age 74 years, 43% women, mean left ventricular ejection fraction 39%), 76 patients (26%) were hospitalized for HF or died within 90 days after discharge. A stepwise Cox regression model selected four significant independent predictors of the composite outcome and each was assigned points proportional to its regression coefficient: NT-proBNP ≥2000 pg/mL (admission) (3 points), systolic blood pressure &lt;120 mmHg (baseline) (2 points), left atrial volume index ≥60 mL/m² (baseline) (1 point) and ≥9 B-lines on predischarge 4-zone LUS (3 points). The weighted risk score provided adequate risk discrimination for the composite outcome (HR 1.48 per 1 point increase, 95% confidence interval: 1.32-1.67, p&lt;0.001, C-statistic: 0.70; Figure 1). In a subset of patients with 8-zone LUS data (n=176), results were similar (C-statistic: 0.72).

Conclusion
A four-variable, weighted risk score integrating clinical, laboratory and ultrasound imaging data provided adequate risk discrimination for 90-day adverse outcomes in patients hospitalized for AHF. If validated in a larger dataset, this score could be used to identify patients needing the closest monitoring, more intensive follow-up and early treatment adjustment.Figure 1.
The prognostic impact of follow-up cardiac Metaiodobenzylguanidine imaging: relation to differential trajectories in left ventricular ejection fraction after acute decompensation
Authors: Kayama K , Yamada T , Watanabe T , Morita T , Kawasaki M , Kikuchi A , Kondo T , Kawai T , Nishimoto Y , Seo M , Nakamura J , Fukunami M 
Published: November 2023

Abstract

Background
Cardiac metaiodobenzylguanidine (MIBG) imaging provides prognostic information in patients with heart failure (HF). Recently, the trajectory of left ventricular ejection fraction (LVEF) has been focused in patients with reduced LVEF admitted for acute decompensated heart failure (ADHF). We sought to prospectively investigate the prognostic value of the follow-up cardiac MIBG imaging in ADHF patients with reduced LVEF, in relation to LVEF trajectory.

Methods
We prospectively studied 145 ADHF patients with reduced LVEF&lt;40%. The cardiac MIBG heart-to-mediastinum ratio (late HMR) was measured on the delayed image at the discharge and 6 months’ follow-up (6FUP). HF recovered LVEF (HFrecEF) was defined as those with a second measurement of LVEF at 6FUP of ≥ 40% with a 10-point increase from baseline LVEF, according to the previous report. Furthermore, in the present study, HFrecEF was classified into the two groups; patients with partial recovery of LVEF (≥40%, &lt;50%) (HFparEF) and complete recovery of LVEF (≥50%) (HFcorEF). The endpoint was a cardiac event (CE) defined as a composite of cardiac death and unplanned hospitalization for worsening HF.

Results
At 6 months after the discharge, HFrecEF was observed in 97 (67%) of 145 study patients and the remaining 48 (33%) patients did not have HFrecEF (HFnorEF). In the subgroup of HFrecEF, 43 (30%) patients had HFparEF and 54 (37%) patients had HFcorEF. Late HMR at 6FUP in HFcorEF patients was significantly greater than those in HFparEF and HFnorEF patients, which was also observed at the discharge with non-significant difference. The change of late HMR significantly correlated with the improvement in LVEF (r=0.33, p&lt;0.001). During a follow-up period of 4.3 ± 2.6 years, 28 patients in HFnorEF, 11 patients in HFparEF and 4 patients in HFcorEF had CEs, respectively. Kaplan-Meier analysis revealed that HFnorEF patients had a significantly higher risk of cardiac events than those with HFparEF and HFcorEF. (58.3% vs 25.6% vs 7.4% P &lt; 0.0001). Patients with lower late HMR at 6FUP had a greater risk of CEs than those with higher late HR at 6FUP in HFrecEF, especially in HFparEF, which was not observed in HFnorEF subgroup.

Conclusion
The follow-up MIBG imaging after the discharge could provide the additional prognostic information in ADHF patients with recovered LV function.
The prognostic impact of cardiac Metaiodobenzylguanidine imaging related to left ventricular geometry in patients with acute decompensated heart failure: a prospective study
Authors: Kayama K , Yamada T , Watanabe T , Morita T , Kawasaki M , Kikuchi A , Kondo T , Kawai T , Nishimoto Y , Seo M , Nakamura J , Fukunami M 
Published: November 2023

Abstract

Background
It is known that changes in the geometry of the left ventricle (LV), such as dilation or hypertrophy, are associated with cardiovascular events. The sympathetic nervous system also plays a crucial role in exacerbating these changes. Cardiac iodine-123 metaiodobenzylguanidine (MIBG) imaging can evaluate cardiac sympathetic neuronal activity and has been strongly associated with poor clinical outcomes in heart failure (HF). However, the prognostic significance of cardiac MIBG imaging related to LV geometry is still unclear, particularly in patients admitted for acute decompensated HF (ADHF).

Methods
We studied consecutive 575 patients admitted for ADHF and echocardiography were performed just before discharge. In cardiac MIBG imaging, the heart-to-mediastinum ratio (HMR) was measured on the delayed image. We divided the patients into four groups according to the relative wall thickness (RWT) and LV mass index (LVMI) based on the ASE/EACVI classification as follows: normal (n=75), normal RWT and LVMI; concentric remodeling (n=56), high RWT and normal LVMI; eccentric hypertrophy (n=298), normal RWT and high LVMI; and concentric hypertrophy (n=146), high RWT and LVMI. The endpoint of this study was all cause death (ACD).

Results
During a follow-up period of 4.2 ± 2.5 years, 272 patients had ACDs (normal [n=32], concentric remodeling [n=28], eccentric hypertrophy [n=137] and concentric hypertrophy [n=75]). There was no significant association between LV geometry and ACDs. At univariate Cox analysis, late HMR was significantly and independently associated with ACDs in the subgroup of patients with eccentric hypertrophy (p=0.0004). However, there was no significant association between late HMR and ACDs in those with other subgroups of LV geometry. At multivariate Cox analysis, late HMR was also significantly associated with ACDs even after adjusting for major HF confounders in the subgroup of patients with eccentric hypertrophy (p=0.0042). Furthermore, Kaplan-Meier analysis revealed that patients with lower late HMR (&lt;1.524: determined by ROC curve analysis) had a significantly higher risk of ACDs in the subgroup with eccentric hypertrophy (61% vs 37%, p&lt;0.0001).

Conclusions
LV geometry has an impact on the prognostic value of cardiac MIBG imaging in patients admitted for ADHF.
The classification shifting and outcomes of DELIVER-type patients with acute heart failure and preserved ejection fraction
Authors: Ling L , Huang W M , Sung S H 
Published: November 2023

Abstract

Background
The DELIVER trial enrolled subjects with acute heart failure (AHF) and preserved ejection fraction (HFpEF) who had elevated biomarkers and cardiac structural abnormalities. Given the benefits of sodium-glucose cotransporter 2 inhibitors (SGLT2i) in AHF, it is important to understand the differences between DELIVER-type and non-DELIVER-type patients and how their classification may shift over time.

Method
This study enrolled patients hospitalized for AHF with LVEF ≥ 50%. Patients with elevated N-terminal pro B-type natriuretic peptide (NT-proBNP ≥ 300 or 600 pg/mL, depending on cardiac rhythm) and cardiac structural abnormalities (enlarged left atrial volume or index, or left ventricular hypertrophy) were classified as DELIVER-type. Patients who did not meet these criteria were classified as non-DELIVER-type. Patients with estimated glomerular filtration rate ≤ 25 mL/min/1.73m2 and those receiving SGLT2i treatment were excluded. Echocardiographic variables were obtained pre-discharge and one year after the index day. All-cause mortality and heart failure hospitalization up to one year were determined by web-based electronic record.

Result
The study included 385 subjects with an average age of 83.7 ± 13.9 years, of whom 53.2% were men. The DELIVER-type group had a higher proportion of atrial fibrillation, larger left atrial volume, thicker left ventricular wall, higher levels of the ratio of early diastolic mitral inflow velocity to early diastolic medial mitral annulus velocity (medial mitral E/e'), and higher pulmonary artery systolic pressure (PASP), as well as more evident haemoconcentration and body weight reduction during hospitalization. Kaplan-Meier curve analysis revealed higher rates of all-cause mortality and hospitalization for heart failure at one year in patients with DELIVER-type (Figure 1). In Cox regression analysis, the DELIVER-type subjects had comparable clinical outcomes after accounting for factors such as age, gender, atrial fibrillation, haemoglobin levels, and estimated glomerular filtration rate, compared to non-DELIVER subjects (hazard ratio and 95% confidence interval of mortality [1.62 (0.81-3.25)]). In one-year follow-up, 41.7% of patients shifted from non-DELIVER type to DELIVER-type, but only 14.6% of DELIVER-type subjects had classification shifting.

Conclusion
Non-DELIVER-type subjects had modestly lower event rates compared to those with DELIVER-type. The high proportion of classification shifting from non-DELIVER-type to DELIVER-type suggested that eligibility could vary during follow-up and that these patients could benefit from SGLT2i therapy.Baseline characteristicsClass shifting in DELIVER type
Regional left ventricular longitudinal strain and heart failure in a low-risk community
Authors: Sengelov M , Kristoffer Grundtvig Skaarup K G S , Mats Christian Hoejbjerg Lassen M C H L , Niklas Dyrby Johansen N D J , Frederikke Vyff F V , Kirstine Ravnkilde K R , Maria Flarup Dons M F D , Adam Femerling Langhoff A F L , Gorm Boje Jensen G B J , Peter Schnohr P S , Rasmus Moegelvang R M , Tor Biering-Soerensen T B S 
Published: November 2023

Abstract

Background
Global longitudinal strain is a well-established prognosticator of heart failure (HF) in the general population. The prognostic values of regional left ventricular (LV) longitudinal strain of the basal, mid and apical regions remain unexplored in the general population.

Purpose
The purpose of this study was to investigate the relationship between regional LV strain and incident HF in the general population.

Methods
This prospective cohort study included randomly selected citizens from a major metropolitan area. All participants were examined with echocardiography. The outcome was incident HF. Participants were excluded if regional LV strain was not assessable in all 3 LV regions or if they had atrial fibrillation or HF at baseline. A multivariable Cox regression model adjusted for sex, age, smoking status, heart rate, systolic blood pressure, history of ischemic heart disease, hypertension, diabetes, LV mass index, LV ejection fraction and E/e’ was used.

Results
A total of 3,952 individuals were included. Mean age was 56±18 years and 43% were male. Mean basal, mid, and apical LV strain was 16.4±2.6%, 19.5±2.6 and 22.8±3.6% respectively. Median follow-up was 5.4 years (IQR: 4.4; 6.3) and 99 developed HF. In multivariable Cox regressions models, only decreasing LV basal strain was associated with future HF (HR = 1.18, 95%CI (1.06; 1.32), P = 0.003, per 1% decrease) (Figure 1). Additionally, LV basal strain provided incremental prognostic information regarding future HF to the Atherosclerosis Risk in Communities HF risk score (continuous net reclassification index = 0.468, 95% CI (0.155; 0.687)).

Conclusion
In individuals from the general population, basal LV strain entailed incremental prognostic information regarding the risk of incident HF.Basal strain and incident HF