bluuebunny/crossref_metadata_2025_split huggingface dataset:
Contrasting patterns of symptoms compared to mortality in women and men with Congestive Heart Failure (the G-CHF registry)
Authors: Walli-Attaei M , Joseph P , Mccready T , Yusuf S 
Published: November 2023

Abstract

Background
There is a paucity of data on the clinical characteristics, management, and outcomes of women compared with men with heart failure, especially in low-and middle-income countries.

Purpose
In this study from the Global Congestive Heart Failure registry, we examined sex differences in risk factors, clinical characteristics, treatments, and the risk of heart failure hospitalization and mortality by country economic status and by left ventricular ejection fraction (LVEF) category.

Methods
In the prospective Global-Congestive Heart Failure (G-CHF) study, participants with established heart failure were considered for inclusion from 40 high-, middle-, and low-income countries. We recorded information on the demographic characteristics, medical history, and treatments of participants. We report data on heart failure hospitalization and mortality by sex overall, by country economic status, and by LVEF category.

Results
From December 2016 to July 2022, 23,000 participants were recruited and followed up. The average age of women in the study was 62 years compared to 64 years in men. Fewer women than men had a LVEF ≤40 (51.7% women vs 66.3% men). By contrast, more women than men had an LVEF≥ 50 (33.2% women vs 18.6% men). Hypertensive heart failure was the most common etiology in women (25.5% women vs 16.8% men), and ischemic heart failure was the most common etiology in men (45.6% men vs 26.6% women). Signs and symptoms of heart failure were more common in women than men: 42.6% of women were NYHA functional class III/IV compared to 37.9% of men. Among participants with a LVEF &lt;35, use of implantable cardiac defibrillator (ICD) was lower in women than men in the overall study (8.7% women vs 17.2% men), and within countries categorized by economic status. However, the use of heart failure medicines and cardiac tests did not differ systematically by sex. Differences by sex were not observed in the adjusted risk of heart failure hospitalization overall (women-to-men adjusted hazard ratio 1.0 (95% CI 0.94 to 1.07)). This pattern was consistent within countries categorized by economic status, geographic region, and by LVEF category. Women had a lower adjusted risk of mortality overall (women-to-men adjusted hazard ratio 0.82 (95% CI 0.77 to 0.87), which was consistently observed within countries categories by economic status, geographic region, and LVEF levels.

Conclusions
There are differences between women and men in heart failure symptoms, underlying causes, ejection fraction categories, and use of an ICD. However, use heart failure medications, cardiac tests, and hospitalization were similar in women and men; but women had a lower risk of death.
Characteristics, clinical presentation and treatment in older patients with cardiac sarcoidosis
Authors: Yoshii T , Kitai T , Sakamoto T , Nakagawa S , Irie Y , Moriuchi K , Amano M , Amaki M , Kanzaki H , Izumi C 
Published: November 2023

Abstract

Background
Patients with cardiac sarcoidosis have high risks of heart failure and lethal arrhythmic events, and often require comprehensive therapies including medications for heart failure, anti-arrhythmic drugs, and immunosuppressive therapy in addition to implantable device therapies. However, controversy exist whether these treatments should be applied to the elderly patients.

Purpose
The aim of this study was to investigate whether older age affects treatment strategy in patients with cardiac sarcoidosis.

Methods
A total of 4,566 patients with hospitalized cardiac sarcoidosis were identified from the Japanese diagnosis procedure combination database from 2012 to 2020. Among them, we analyzed 1,946 patients who were initiated corticosteroid therapy during the hospitalization. Patients’ characteristics and treatment including starting dose of corticosteroid therapy were compared between patients aged ≧ 70 years and those with &lt; 70 years.

Results
A mean age was 63±11 years, and 1,256 patients (64.5 %) were female. Older patients (age ≧ 70 years , n = 599 [30.8%]) had lower BMIs (22.4±3.7 vs 23.1±4.1 kg/m2, p = 0.001), and higher prescription rates of diuretics (268 [44.7 %] vs 488 [36.2%], p&lt;0.001) , calcium channel broker (162 [27.1%] vs 195 [14.5%], p&lt;0.001), anti-diabetes drugs (204 [34.1%] vs 344 [25.5%], p&lt;0.001), statin (252 [42.1%] vs 461 [34.2%], p = 0.001), anti-coagulant therapy (322 [53.8%] vs 658 [48.9%], p = 0.050), and anti-platelet therapy (119 [19.9%] vs 106 [7.9%], p&lt;0.001). There were no significant differences regarding beta-blockers, angiotensin converting enzyme inhibitors or angiotensin receptor blockers, mineralocorticoid receptor antagonists, SGLT-2 inhibitors, amiodarone, and immunosuppressive therapies except for corticosteroids. The starting dose of corticosteroids were significantly lower in the older group (37 vs 46 mg/day, p&lt;0.001). In addition, older patients were associated with a higher risk of hospitalization due to acute decompensated heart failure (53 [8.9%] vs 78 [5.8%], p = 0.014), while patients with age &lt;70 years had a higher risk of fatal ventricular arrhythmia (11 [1.8%] vs 49 [3.6 %], p = 0.033). Thirty days mortality and the prevalence of cardiac resynchronization therapy were similar between both groups (5 vs 3, p = 0.064; 2 [2.4%] vs 71 [3.8%], p = 0.768, respectively).

Conclusion
Older patients with cardiac sarcoidosis tended to be treated with lower doses of corticosteroids, and were more likely to admit due to heart failure exacerbation, while the risks of arrhythmic events were higher in the younger group.
Change in incidence of ischemic stroke and mortality among patients with atrial fibrillation over a period of 30 years, a nationwide, register-based cohort study
Authors: Basic C , Spanos E , Mandelenakis Z , Zverkova-Sanstrom T , Rosengren A 
Published: November 2023

Abstract

Background
During the last decades we have faced large changes in lifestyle and cardiovascular risk factor patterns, as well as screening and treatment advances of patients with atrial fibrillation (AF).

Aim
To investigate trends in ischemic stroke (IS) and mortality in Sweden over a period of 30 years among patients with AF and compare it to matched controls without AF.

Methods
This is a Swedish nationwide registry-based retrospective case-control study of patients diagnosed with AF combining data from National Patient Register (NPR) and Cause of Death Register between 1987 and 2018. Controls were defined as Swedish inhabitants without AF and matched by age, sex and county. With the use of international classification of diseases (ICD) 9- and 10- codes we identified all patients diagnosed with AF, and comorbidities at baseline from NPR.

Results
In total, we identified 739,388 patients with AF and 1,386,448 matched controls. The mean age of the study population was 78.8 (12.6); and (46.2%) were female. Cochran-Armitage test showed a significant increase of all comorbidities over time, except for myocardial infarction for patients and PAH för controls. The Incidence rate for IS per 1000 person-year within one year declined from 40.9 (95% C.I.: 30.1-55.6) in 1987 to 16.2 (95% C.I.: 9.9-26.4) in 2017 (p &lt;.0001) for patients with AF and from 12.2 (95% CI: 7.0-21.4) in 1987 to 6.2 (95% CI: 2.8-13.7) in 2017 (p &lt;.0001) in controls. The prescription of oral anticoagulant therapy (OAK) increased from 40% in 2006 to almost 80% in 2018. The total 1-year mortality rate of IS was at 175.4 (151.3-203.4) for AF cases and 58.3 (45.1-75.4) for controls (p&lt;0001). Compared to controls and adjusted for age, sex and comorbidities patients had HR for IS at 3.01 (95% CI: 2.89-3.13) between 1987 and 1999 that decreased to HR 2.75 (95% CI: 2.63-2.88) between 2010 and 2017 in patients with AF. After adjustment for baseline comorbidities and OAK the one-year risk for IS decreased from HR 1.01 (95% CI: 0.95-1.08) in 2012 to 0.41 (95% CI: 0.36-0.47) in patients and HR 0.50 (95% CI: 0.43-0.58) in 2012 to 0.37 (95% CI: 0.31-0.43) in controls, respectively (both p&lt;0.0001).

Conclusions
This study revealed significant prognostic improvement of patients with AF showing decrease in the incidence rate and relative risk for IS, as well as all-cause mortality within one year of AF diagnose. The prescription of OACs almost doubled between 2006 and 2018 in patients with AF and was associated with a significant decrease of the relative risk for IS to almost same level as in controls without AF.
Non-invasive pressure-volume loops from cardiovascular magnetic resonance predict cardiovascular mortality in heart failure with reduced ejection fraction
Authors: Arvidsson P M , Berg J , Jablonowski R , Carlsson M , Arheden H 
Published: November 2023

Abstract

Background
Heart failure with reduced ejection fraction (HFrEF) is characterized by impaired ventricular energetics secondary to ventricular remodeling. Left ventricular pressure-volume (PV) loop analysis (Figure 1) can now be performed noninvasively using cardiovascular magnetic resonance (CMR) imaging, enabling study of cardiac thermodynamic efficiency without the risk and cost associated with invasive measurements (1–3). Here we investigated whether noninvasive PV loops from CMR can predict cardiovascular death in HFrEF patients.

Methods
We analyzed 135 datasets (age 60±12 years, 79% male) from HFrEF patients (LVEF≤40%) who underwent clinical CMR examination at our center between 2004-2013. Pressure-volume loop parameters were computed from manually segmented CMR data and same-day brachial blood pressure (Segment 4.0 R11026, Medviso, Lund, Sweden). The primary endpoint was cardiovascular mortality extracted from national registries with a 5-year follow-up. Parameters of interest were selected from univariate Cox regression, and associations with clinical outcome evaluated using multivariate Cox regression. Survival was visualized using Kaplan-Meier analysis. Statistical analysis was performed in R 4.0.3 (R Core Team).

Results
A total of 19 deaths from cardiovascular causes occurred during follow-up. Univariate Cox regression found stroke work (SW, joule), ventricular efficiency (VE, %), external power (J/s), contractility (mmHg/ml), and energy per ejected volume (mJ/ml) computed from PV loops associated with the primary endpoint alongside age, LVEF, and NT-proBNP level. In multivariate Cox regression adjusted for age, ventricular efficiency remained significant (HR 0.86, p&lt;0.001), while EF did not (p = 0.077). Event-free survival is shown in Figure 2.

Conclusion
Ventricular efficiency derived from non-invasive pressure-volume loop analysis from standard CMR scans, may outperform LV EF as a predictor of cardiovascular mortality in HFrEF.
Figures:
Figure 1. Example of left ventricular pressure-volume (PV) loop. The area enclosed by the loop is the stroke work (SW). The area bounded by the PV loop and the end-systolic pressure-volume relationship (ESPVR) is the potential energy (PE). Ventricular efficiency (VE) is calculated as SW/(PE+SW).
Figure 2. Kaplan-Meier plots of survival by tertiles of stroke work and ventricular efficiency.Figure 1Figure 2
Prognostic evaluation of heart failure in women: insight from the MECKI score database
Authors: Salvioni E , Moscucci F , Bonomi A , Mapelli M , Paolillo S , Corra U , Vignati C , Mattavelli I , Magri D , Sciomer S , Piepoli M , Agostoni P 
Published: November 2023

Abstract

Background
Heart failure (HF) in women often assumes extremely peculiar characteristics. The risk stratification and prognostic evaluation of HF in women is a challenge for clinicians. The actual prognostic scores are, in fact, lacking a specific sex-oriented assessment. In HF women show better survival despite a comparatively low peak oxygen consumption (VO2) at cardiopulmonary exercise testing: this raises doubt about the accuracy of risk assessment in women. Previous studies on MECKI score database have demonstrated that female prognostic advantage is lost when sex-specific differences are correctly considered.

Purpose
The present analysis has the aim to identify parameters which could be differently associated to prognosis in men and women and to re-calibrate the MECKI score according to these differences.

Methods
The new weights of the MECKI score variables according to gender, were calculated using the means of the 200 repetitions obtained to cross-validation procedure. The primary outcome of the study was the composite of all-cause mortality, urgent heart transplant and LVAD implant. The difference in predictive ability between the native and gender re-calibrated MECKI was calculated with the ROC curve at 2 years follow-up and calibration plot.

Results
We retrospectively analyzed 7900 HF patients with reduced ejection fraction included in the MECKI score registry (61±13 years, 6456 M/ 1444 F, LVEF 33±10%, VO2 /kg 14.9±4.9 mL/min Kg). Patients follow up was: 4.05 years [1.72-7.47]. Table 1 presents the weights of the individual MECKI variables for males and females. The main differences have been detected for the intercept value, hemoglobin and Na+. We used these variables to recalibrate the algorithm of MECKI score. We obtained higher AUC for MECKI re-calibrated by gender than for Native MECKI (0.7893 vs. 0.7799, p = 0.0194, Fig. 1 left panel). Moreover, the gender MECKI was better calibrated (Fig. 1, right panels).

Conclusions
The calibration of MECKI Score according to gender specific differences improves the prognostic power and accuracy of mortality prediction at two years follow up.Fig 1Table 1
Role of renal function in patients with advanced heart failure: insights from the help-hf registry
Authors: Villaschi A , Chiarito M , Pagnesi M , Stolfo D , Baldetti L , Lombardi C M , Adamo M , Loiacono F , Merlo M , Cappelletti A M , Sinagra G , Metra M , Pini D 
Published: November 2023

Abstract

Background
Chronic kidney disease (CKD) and heart failure (HF) strongly interact in determining patients prognosis. However, the prevalence and impact of CKD in advanced HF is still poorly characterized.

Objective
To determine the prevalence and prognostic impact of CKD and how estimated glomerular filtration rate (eGFR) might limit the use of guideline directed medical therapy in a large cohort of HF patients with at least one high-risk I NEED HELP marker.

Methods
1120 patients enrolled in the HELP-HF registry were included in the analysis; eGFR was calculated according to the Chronic Kidney Disease Epidemiology Collaboration formula. Patients were stratified according to eGFR into three categories (&gt; 60 ml/min, 30-60 ml/min, &lt;30 ml/min). The primary endpoint was a composite of all-cause death and HF-hospitalization. Secondary endpoints were all-cause death, HF-hospitalization and cardiovascular death.

Results
291 patients (25.98%) had an eGFR&gt;60 ml/min, whereas 497 (44.37%) had eGFR between 30 and 60 ml/min and 332 (29.64%) had &lt;30 ml/min. The risk of the primary endpoint was increased in patients with worse renal function (eGFR 30-60, HR 1.34, 95%CI 1.05-1.71, p = 0.017; eGFR&lt;30, HR 1.88, 95%CI 1.47-2.42, p&lt;0.001), whereas only patients with eGFR&lt;30 ml/min demonstrated higher risk of all-cause death (HR = 2.36, 95%CI 1.68-3.31, p&lt;0.001) and CV death (HR = 3.08, 95%CI 2.00-4.75, p&lt;0.001). No difference in HF hospitalizations was seen with respect to patients with eGFR&gt;60 ml/min. Once analyzed as a continuous variable, eGFR was significantly associated with each outcome. The impact of CKD was also confirmed in patients fulfilling the 2018 ESC-HFA definition of advanced HF. Logistic regression showed that patients with lower eGFR and with HF with reduced (HFrEF) and mildly reduced ejection fraction (HFmrEF) were less frequently discharged on maximal tolerated dose of mineral corticoid receptor antagonists (p= 0.001 for HrEF, p= 0.013 for HFmrEF), while lower eGFR was associated with less frequent use of maximal tolerated dose of a renin-angiotensin inhibitors (including angiotensin receptor-neprilysin inhibitors) only among patients with HFmrEF (p = 0.018).

Conclusions
Chronic kidney disease is highly prevalent among patients with advanced HF and impacts on patients’ prognosis and survival. The use of GDMT was significantly limited in patients with lower eGFR only in patients with HFrEF and HFmrEF.
Regional levels of tenascin- C in patients with heart failure and atrial fibrillation
Authors: Grosse A , Mettke F , Kirsch K , Gruen K , Franz M , Schulze P C , Surber R 
Published: November 2023

Abstract

Background
Tenascin-C (TNC) is an extracellular matrix glycoprotein that is upregulated at high levels during active tissue remodeling. The serum concentration of TNC has been reported to be increased in patients with several cardiac diseases. The aim of this study was 1) to measure the TNC plasma level in heart failure (HF) and atrial fibrillation (AF) patients compared to patients without structural heart disease and 2) to search for a local production in the heart.

Methods
This study included 13 patients with HF who underwent CRT- implantation (CRT- group), 13 patients with persistent AF who underwent left atrial catheter ablation (AF- group) and 13 patients without structural heart disease or AF, who underwent electrophysiological study (Control- group). Blood was collected at the beginning of the procedures from the coronary sinus (CS), superior vena cava (SVC) and aorta (Ao). Level of TNC-B (ng/dl) in the CS (TNC-CS), SVC (TNC-SVC) and aorta (TNC-Ao) was measured.

Results
Patients characteristics: CRT- group: mean age 74y, 8 male, LV- EF 32%, 3 with a history of atrial fibrillation. AF- group: mean age 68y, 9 male, LV- EF 55%. Control- group: mean age 54y, 9 male, LV- EF 65%.
The TNC level in the SVC was in the CRT group significant elevated (6125 ± 2030 ng/ml vs 475 ± 238 ng/ml in controls (p&lt;0.01). In the AF group the TNC level in the SVC as well was significantly higher 4983 ± 1814 ng/ml vs 475 ± 238 ng/ml in controls (p&lt;0.01). The TNC level of the CRT- and the AF- group were not significant different (p= 0.219) (Figure 1). No significant differences were noted at the various collection sites (CS, SVC and aorta) between the 3 groups (p = 0.38).

Discussion
The TNC serum levels in HF- and AF- patients are elevated compared to a control group without structural heart disease and without a history of AF. We could not determinate, the source of serum TNC, differences in the level of TNC between CS and SVC and aorta were not visible. Whether an effective treatment of HF and AF will lower TNC levels and slow the disease progression needs to be evaluated in further studies.
Selenium deficiency is associated with anemia in heart failure patients - The HARVEST Study
Authors: Molvin J , Jujic A , Holm H , Dieden A , Korduner J , Zaghi A , Nezami Z , Bergmann A , Schomburg L , Magnusson M 
Published: November 2023

Abstract

Background
Heart failure (HF) patients with anemia have worse clinical outcomes with increased hospitalization rates, decreased exercise tolerance, and higher mortality compared to those without anemia. Previous studies have indicated a correlation between selenium deficiency and anemia in healthy elderly individuals and in pregnant women. The BIOSTAT-CHF study reported that HF patients with higher selenium levels were less likely to have anemia or iron deficiency. These studies suggest that selenium deficiency can lead to the development of anemia. However, studies regarding this association in HF patients are limited.

Purpose
The purpose of this study was to examine the relationship between selenium deficiency, measured by selenoprotein P (SELENOP) levels, and anemia, hemoglobin levels, and iron state in subjects with acute HF.

Methods
SELENOP, a well-validated plasma marker of selenium status, was measured in 320 subjects hospitalized for HF in the Swedish HeArt and bRain failure inVESTigation trial (the HARVEST study). Of these subjects, 310 had complete data on all covariates. Prior to analyses, skewed variables were ln-transformed. The relationships between continuous SELENOP levels and 1) Hb levels, 2) anemia (Hb &lt; 115 g/L (women), &lt; 130 g/L (men)), and 3) iron status (as measured by transferrin receptor 1 (TfR1) which increase in iron deficiency) were evaluated using multivariable logistic and linear regression models adjusting for age, sex and renal function (cystatin C). Additionally, selenium deficiency was defined as SELENOP levels in the lowest quartile and its association with anemia, hemoglobin, and iron state was explored in multivariable logistic and linear models.

Results
Anemia was present in 133 subjects (42.9%). SELENOP levels were positively correlated with hemoglobin levels (0.238; p = 2.3x10-5) and negatively associated with TfR1 levels (-0.238, p = 2.0x10-6). In multivariable linear regression models, each 1 standard deviation increase in SELENOP was linked to higher Hb levels and lower TfR1 levels (Table 1). Furthermore, selenium deficiency was associated with lower Hb levels, higher TfR1 levels, and higher odds of anemia in HF patients (Table 1).

Conclusions
In acute heart failure patients, lower levels of selenoprotein P were associated with lower hemoglobin levels, higher transferrin receptor 1 levels, and a higher prevalence of anemia.
Cardiac Troponin T level is not a predictor of mortality in patients with post-cardiotomy shock supported with venoarterial extracorporeal membrane oxygenation
Authors: Celinska-Spodar M , Marta Zaleska-Kociecka M , Ilona Kowalik I , Kusmierczyk M , Kusmierski K , Sitkowska-Rysiak E , Szymanski J , Stepinska J 
Published: November 2023

Abstract

Background
The prognostic significance of a dominant biomarker of cardiac injury, troponin, is unexplored in patients with post-cardiotomy cardiogenic shock supported with venoarterial extracorporeal membrane oxygenation (PCCS–VA-ECMO).

Aims
We sought to investigate the association of early postoperative troponin T with short- and long-term mortality in patients supported with VA-ECMO in the postoperative period.

Methods
We analyzed 1457 troponin measurements of 102 patients with PCCS–VA-ECMO treated between 2013–2018 in a cardiosurgical and transplantation centre. We focused on the relation of troponin concentration 24–48 hours after surgery and 24–48 hours after VA-ECMO implantation and peak troponin value with VA-ECMO weaning, 90-day and one-year mortality.

Results
The median troponin T 24–48 hours following VA-ECMO implantation was 1338 ng/L [Q1–Q3: 526–2727, 90-day survivors 1529 ng/L (Q1–Q3: 836–5791) vs. non-survivors 1294 ng/L (Q1–Q3: 316–2657); P = 0.146]. The median peak troponin was 3583 ng/L [Q1–Q3: 1710–9238, 90-day survivors 3337 ng/L (Q1–Q3: 1863–12305) vs. non-survivors 3666 ng/L (Q1-Q3: 1462–9238); P = 0.709]. Multivariate models of troponin analysis: for VA-ECMO explanation, in-hospital, 90-day and 1-year mortality showed no relation between troponin and mortality. Age, urgency, type and number of procedures, left ventricle ejection fraction before surgery, Euroscore II result, cardiac arrest prior to VA-ECMO implantation or duration of VA-ECMO did not correlate with the extent of troponin release. The strongest risk factor for short- and long-term mortality was the need for hemodiafiltration [HR 2.4].

Conclusions
Isolated early Troponin T release and peak troponin T were not associated, while organ complications were linked with VA-ECMO weaning or short- and long-term prognosis. The results underscore the multiorgan implications of PCCS in determining survival.