bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association between aortic valve opening during exercise and right ventricular reserve in patients with left ventricular assist device
Authors: Takenaka S , Sato T , Nagai T , Omote K , Kamiya K , Konishi T , Kobayashi Y , Tada A , Mizuguchi Y , Takahashi Y , Naito S , Saiin K , Ishizaka S , Wakasa S , Anzai T 
Published: November 2023

Abstract

Background
Aortic valve (AV) opening in patients after left ventricular (LV) assist device (LVAD) implantation is important to prevent adverse events. We hypothesised that right ventricular (RV) reserve function would play a crucial role to overcome pulmonary vascular resistance to ensure LV filling and AV opening in LVAD patients. However, detailed analysis between RV haemodynamic exercise response and AV opening with recent LVAD patients remains relatively unknown.

Purpose
The aim of this study was to explore the haemodynamic parameters observed during rest and maximal exercise and investigate the association of AV opening with RV reserve function and adverse events in patients with LVAD.

Methods
We prospectively examined 22 consecutive LVAD patients who were admitted to our university hospital between June 2020 and December 2022 after excluding those who were unable to perform exercise (n = 8). All patients underwent invasive exercise right heart catheterisation with simultaneous echocardiography in the supine position. AV status was assessed at rest and during exercise. RV stroke work index (RVSWI) was calculated as 0.0136 × stroke volume index × (mean pulmonary artery pressure – right atrial pressure) at rest and during exercise. RVSWI change from rest to peak exercise (ΔRVSWI) were calculated to evaluate RV reserve function. The patients were divided into three groups according to AV opening both rest and exercise (n = 6), AV opening only during exercise (n = 7), and AV closed both rest and exercise (n = 9).

Results
Patients were predominantly male (77%) and the median age was 51 (interquartile range [IQR] 39-63) years. There were no significant differences in age, sex, primary aetiology of heart failure, type of LVAD devices or echocardiographic parameters and RVSWI at rest among the groups. Patients with AV opening both rest and exercise, and only during exercise had significantly higher ΔRVSWI than those with AV closed both rest and exercise (Figure A). During a median follow-up period of 433 (IQR 228-558) days, adverse events occurred in six patients (27%), including one death, one hospitalisation for major bleeding, and four hospitalisations for right heart failure. Kaplan–Meier analysis revealed that the adverse events more frequently occurred in patients with AV closed both rest and exercise compared to those with AV opening (p = 0.014) (Figure B).

Conclusions
In patients with LVAD, AV opening at rest or during exercise was associated with preserved RV reserve function and less adverse events. These findings suggest that the observation of the AV opening during exercise would be useful for early identification of high-risk patients with LVAD. Further studies are needed to confirm our findings.
Post-transplant left atrial function depends on the technique used for orthotopic heart transplantation
Authors: Obremska M , Przybylski R , Sokolski M , Rakowski M , Zakliczynski M , Ponikowski P , Kosmala W 
Published: November 2023

Abstract

Background
Even short episodes of post-transplant atrial fibrillation (AF) have been shown to increase the risk of adverse outcomes, including thromboembolic events, graft failure, and increased mortality. Of the two most commonly used heart transplantation techniques - bicaval and total orthotopic heart transplantation (OHTx), the former approach combines the donor and recipient atria, and may predispose to supraventricular arrhythmias, especially atrial fibrillation, as well as lead to a higher incidence of atrioventricular valve incompetence. Existing data relate mainly to the more non-physiological left atrial (LA) size and geometry after bicaval OHTx, while little is known about differences in LA function between patients treated with both techniques.

Aim
To compare LA functional and morphological characteristics between patients after bicaval and total OHTx.

Methods
The study group consisted of 28 patients who underwent OHTx between May 2021 and December 2022: 14 consecutive patients after total OHTx and 14 subjects after bicaval OHTx matched by age and time from heart transplant. Echocardiographic examination included standard measurements and left ventricle (LV) and LA longitudinal deformation assessment by speckle tracking technique.

Results
All enrollees were male. There were no differences between the groups after total and bicaval OHTx in anthropometric and laboratory parameters. Routine endomyocardial biopsies performed during follow-up after OHTx in all patients did not show severe graft rejection. No significant differences were found in LV dimensions, ejection fraction and stroke volume, Doppler velocities of mitral inflow and mitral annulus, as well as LV global longitudinal strain. In contrast to LV measures, significant between-group differences were demonstrated for LA parameters: LA volume index was significantly higher, and peak atrial longitudinal strain (PALS) corresponding to LA early diastole in the reservoir phase and peak atrial contraction strain (PACS) corresponding to LA systole were significantly higher in the total OHTx group than in the bicaval OHTx group (Table).

Conclusions
Total OHTx technique is associated with a more favorable LA morphology and function, which may explain the lower prevalence of atrial fibrillation reported in the literature in patients treated with this method. The clinical significance of reduced LA contribution to LV filling in patients subjected to bicaval OHTx needs further exploration.
Predictors on admission associated with successful weaning and in - hospital mortality in patients with refractory shock undergoing veno - arterial extracorporeal membrane oxygenation
Authors: Hong J Y , Hong J A , Kim S A , Kim H S 
Published: November 2023

Abstract

Introduction
In assessment of prognosis of patients undergoing veno-arterial extracorporeal membrane oxygenation (VA-ECMO), considerable data have been focused on predictors just before or after VA-ECMO initiation. The aim of this study is to determine the prognostic factors on admission in patients with refractory shock undergoing VA-ECMO.

Methods
A total of 307 patients (median age 57; interquartile rate [IQR]: 48-68, male 220 (72%)) who underwent VA-ECMO due to refractory shock from 2015 to 2021 were retrospectively analyzed. Successful weaning was defined as successful removal of VA-ECMO without mechanical support over the following 30 days. In-hospital mortality (IHM) was defined as death occurred during the hospital stay.

Results
Median duration of weaning and hospital stay was 10 days (IQR: 7-14) and 24 days (IQR: 9-43), respectively. Of all patients, 115 patients (37%) were successfully weaned from VA-ECMO and 191 (62%) died before discharge. Patients with successful weaning and survived before discharge had lower prevalence of sepsis, higher cystatin C based estimated glomerular filtration rate (cyc-eGFR) and total cholesterol, and lower blood urea nitrogen, C-reactive protein and INR on admission than those with failed weaning and those who had died. In multivariate regression analyses, sepsis, cyc-eGFR and INR on admission were independently associated with successful weaning and only cyc-eGFR on admission was remained as independent predictor of IHM. In an incremental model, the addition of cyc-eGFR significantly increased the χ² of the clinical and laboratory data model including creatinine based eGFR (Cr-eGFR), from 22.3 to 33.7 (p&lt;0.001) for prediction of successful weaning and from 22.2 to 33.6 (p&lt;0.001) for prediction of IHM, respectively.

Conclusion
Cyc-eGFR on admission showed an incremental prognostic value beyond Cr-eGFR on admission for prediction of successful weaning and IHM in patients with refractory shock undergoing VA-ECMO.
Urinary proteomics signature of malignancy post heart transplantation is associated with mortality risk
Authors: Wei D , Vanassche T , Verhamme P , Janssens S , Van Aelst L , Van Cleemput J , Zhang Z Y 
Published: November 2023

Abstract

Background
Heart transplant recipients are at an increased risk of malignancy that has an adverse impact on outcomes. The surveillance of malignancy after heart transplantation is cumbersome and involves multidisciplinary efforts.

Purpose
This study aimed to identify potential urinary proteomic biomarkers for the detection of malignancy and their predictive value for mortality risk after heart transplantation.

Methods
Urinary samples from 343 heart transplant recipients, including 27 with solid organ cancer, 23 with skin cancer, and 293 without cancer, were measured at baseline by capillary electrophoresis coupled with mass spectrometry. Multivariable logistic regression models and partial least squares-discriminant analysis were used to identify proteome differences between cancer and non-cancer patients. The association between proteomic signatures and mortality was assessed by Cox regression analysis.

Results
The urinary proteomics difference between solid organ cancer and non-cancer was 30 peptides involved in collagen degradation, cell adhesion and apoptosis, and tumorigenesis. The proteomic signature of skin cancer was comprised of 39 peptides related to collagen turnover, cell migration and invasion, and proliferation. These two proteomic signatures yielded an AUC of 0.93 (95% CI: 0.90-0.97) and 0.92 (0.88-0.97) for the detection of solid organ or skin cancer (P&lt;0.0001), respectively. The corresponding AUCs provided by multiple clinical factors (sex, age, year after transplantation, immunosuppressive agents, blood pressure, HDL cholesterol, and eGFR) were 0.88 (0.82-0.93) and 0.82 (0.72-0.92). The proteomic signature of solid organ cancer (adjusted hazard ratio: 1.04 [1.01-1.07], P=0.007) and its constituted peptides (collagen type III and I, MLL cleavage product C180, and CD99 antigen-like protein 2) were significantly associated with mortality.

Conclusions
Urinary proteomic biomarkers might be used to screen malignancy after heart transplantation. Proteins involved in collagen metabolism, cell adhesion and proliferation, and tumorigenesis predicted cancer mortality after heart transplantation.Figure 1.WorkflowFigure 2.ROC curves
Predictors and outcomes of rejection requiring treatment within the first year following heart transplantation
Authors: Doulamis I , Tzani A T , Gemelli M G , Rempakos T R , Kampaktsis P K , Alvarez P A , Guariento A G , Briasoulis A B 
Published: November 2023

Abstract

Background
Heart transplant remains the mainstay of treatment for end stage heart failure not controllable with maximum pharmacotherapy or surgical interventions. One of the main considerations regarding heart transplant is the risk for graft rejection and the need for immunosuppression therapy to mitigate that risk.

Purpose
To assess the impact of the need for immunosuppression for rejection treatment within one year for heart transplantation on mortality. Secondary objectives include risk factors for the need for anti-rejection treatment.

Methods
The United Network for Organ Sharing (UNOS) Registry was queried to identify patients who solely underwent heart transplant in the US between 2000 and 2021. Patients were divided into two groups according to the need for antirejection treatment within one year from heart transplantation.

Results
Patient demographics are summarized in Figure 1. Patients who required treatment for rejection within one year after transplant were younger (49±14 vs 52±14 years, p&lt;0.001) and had higher CPRA value (14±26 vs 11±23, p&lt;0.001) than patients who did not require treatment. Moreover, the majority of the patients who did not require antirejection treatment underwent heart transplantation during the new allocation era, while less than half of the patients who required treatment underwent transplant after the new allocation policy implementation (65% vs 49%, p&lt;0.001). The latter group had higher risk for 10-year mortality (HR: 1.34; 95% CI: 1.29, 1.39, p&lt;0.001; Figure 2), although no difference was noted at the 1-year timepoint.

Conclusions
Although medical treatment of acute rejection was associated with similar 1-year mortality with patients who did not require antirejection therapy, 10-year mortality was higher in this patient population. Further studies and newer follow up data are required to investigate the role of antirejection therapy in the heart transplant population.Figure 1Figure 2
Non-HLA autoantibodies supplement donor specific antibodies in predicting graft survival after heart transplantation
Authors: Oh G , Lee H Y , Song E Y 
Published: November 2023

Abstract

Background
Presence of antibodies to donor-specific human leukocyte antigens (HLA) is a well-known risk factor associated with outcome in heart transplantation (HTx). However, non-HLA have also been associated with graft outcomes in HTx.

Purpose
We sought to assess the effect of non-HLA antibodies on graft outcome in Korean HTx patients.

Methods
Pre-transplant serum from patients undergoing HTx from January 2014 to December 2016 in four large transplant centers in Korea were analyzed. Presence of increased non-HLA antibodies, and their association with early (≤ 1-year) and long-term graft failure were assessed.

Results
Non-HLA antibodies were assessed in 192 patients. Antibodies to vimentin (AVA+) and type II collagen (ACA+) were associated with a lower rate of 1-year graft survival (78.6% vs. 92.6%-, log-rank p=0.006 for AVA+; 72.2% vs. 91.1%, log-rank p=0.015 for ACA+). Additionally, AVA+ stratified 1-year graft survival in patients with donor specific antibodies (DSA+) (45.5% vs. 94.1%, log-rank p=0.002). AVA+ also improved the prediction model for 1-year graft survival when added to known risk factors (IDI=11%, p=0.002; NRI=23%, p=0.047). ACA+ was also associated with lower rates in late graft survival (66.3% vs. 88.6%, log-rank p&lt;0.001). Compared to AVA-/ACA- patients, AVA+/ACA+ patients had significantly poor graft survival both in the early and late periods (all log-rank p&lt;0.001).

Conclusion
In our analysis of patients undergoing HTx, presence of non-HLA antibodies to vimentin and type II collagen were associated with poor graft outcomes. Pre-transplant assessment of non-HLA antibodies could help predict outcomes and tailor graft allocation and post-HTx immunotherapy in specific patients.Kaplan-Meier curves for graft survival
Reduced trans-myocardial extraction of endothelin-1 in cardiac allograft vasculopathy
Authors: Abraham G R , Davenport A P , Hoole S P 
Published: November 2023

Abstract

Introduction
Cardiac allograft vasculopathy (CAV) is a major cause of graft failure due to microvascular dysfunction and ischaemia following heart transplant. Endothelin-1 (ET-1) is an endothelium derived vasoconstrictor peptide with multiple adverse effects including vascular smooth muscle proliferation and pro-inflammatory signalling. Elevated circulating ET-1 has been associated with accelerated CAV.
We assessed the trans-myocardial gradient (TMG: coronary sinus minus coronary artery concentration: negative=extraction, positive=secretion) of ET-1 in heart transplant patients to determine correlations with angiographic, Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) features of CAV.

Methods
23 patients underwent invasive coronary angiography, 3-vessel grey scale IVUS (Opticross, 60mHz, Boston Scientific) and OCT (Dragonfly, Abbott Vascular) to define morphological features of vasculopathy 18±3 months post-transplant. Paired blood samples were obtained from the guide catheter and coronary sinus at the time of coronary imaging. Plasma was analysed using specific enzyme-linked immunosorbent assay for ET-1 peptide quantification. Survival was determined 98±5 months after initial assessment.

Results
ET-1 TMG distribution was mostly in the negative range reflecting net extraction across the coronary vascular bed (median [IQR]: -0.23 [-0.54, -0.02] pg/ml). However, vessels with more severe CAV demonstrated significantly more positive TMG i.e. less ET-1 trans-myocardial extraction (IVUS Stanford Grade IV: -0.05 [-0.21, 0.13] pg/ml versus Stanford Grade I-III: -0.31 [-0.64, -0.11] pg/ml, p = 0.01). ET-1 TMG was positively correlated with mean intimal thickness on both IVUS and OCT (IVUS: Kendall’s tau-b = 0.254, p=0.02 and OCT: Kendall’s tau-b = 0.344, p&lt;0.0001). Patients who died had net ET-1 secretion compared with surviving patients (died: 0.21 [0.19 - 0.24] versus surviving: -0.28 [-0.52, -0.17], p = 0.01).

Conclusions
In heart transplant patients, coronary arteries with more intimal thickening had less trans-myocardial extraction, and more secretion of ET-1. ET-1 secretion in CAV may mediate the distal microvascular dysfunction commonly seen in this condition. These findings suggest a rationale for testing ET-1 receptor antagonists as a treatment for CAV.ET-1 TMG and IVUS Stanford Grade of CAVET-1 TMG and OCT derived MIT
Impact on mortality of heart transplantation preceded or not by continuous-flow left ventricular assist devices
Authors: Nafeh-Bizet C , Dumont M , Fauvel C , Aludaat C , Le Guillou V , Bouchart F , Olivier M E , Nardone N , Gay A , Omouri L , Bauer F 
Published: November 2023

Abstract

Background
Heart transplant (HT) is the therapy of choice in end-stage heart failure patients. With the scarcity of donors, bridge to transplantation (BTT) with left ventricular assist device (LVAD) becomes an option in patients awaiting HT. Criteria for HT listing do not differ between patients medically managed and those mechanically bridged to HT.

Objectives
The objectives of the present study is to assess the survival following HT preceding or not with LVAD as BTT and to evaluate differences in risk factors for 4-year mortality between those with (LVAD +) and those without LVAD (LVAD -) at the time of HT.

Methods
Using the local database, we identified 145 heart-transplanted adults (LVAD +, n=28 and LVAD -, n=117) between 2000 and 2020. Patients were propensity matched for likelihood of LVAD at the time of HT. Kaplan-Meier survival estimates were used to assess the impact of BTT on 30-day and 4-year mortality. Logistic regression analysis was used to evaluate the odds ratio of 4-year mortality for patients BTT with LVAD compared with those with medical management across clinically significant variables at various thresholds.

Results
30-day and 4-year post HT mortalities were similar in mechanically bridged patients or not: 10,7% versus 11,1% mortality (P=0,71), and 32,1% versus 35,9% mortality (P=0,61), respectively. Because outcomes were similar in both groups, risk factors for 4-year mortality were investigated in the total cohort of HT. Diabetes at the time of HT (CI [1.93–10.72], OR=4,55, p= 0.001), early post-HT hemorrhage (CI [2,01–15.23], OR=5,53, p= 0.001), and ventricular arrhythmia (CI [1.08–7,51], OR=2,84, p= 0.001) and late HT antidepressant drugs use (CI [0,02–0,51], OR=0,11, p= 0.005), incurred in the risk of 4-year mortality.

Conclusions
Bridge to HT with LVAD, although necessary because of organ scarcity and capable of improving wait list survival, confers no significantly risk of early and late posttransplantation mortality. Diabetes may require more careful consideration for transplant eligibility while antidepressant use are protective.Figure 1
Sleep apnea in patients with exacerbated heart failure and overweight
Authors: Kalaydzhiev P , Poroyliev N , Spasova N , Krastev B , Markov D , Kinova E , Goudev A 
Published: November 2023

Abstract

Background
Exacerbated heart failure is a condition with a high frequency of hospitalizations and mortality, especially in overweight patients. Screening and treatment for sleep apnea can be helpful in these patients.

Purpose
To determine the frequency and the phenotypic characteristics and of sleep apnea in patients with overweight and exacerbated heart failure. To assess systolic and diastolic function in patients with obstructive and central sleep apnea. To follow patients for one year and to assess hospitalization and mortality.

Methods
We conducted a single-centre, prospective cohort study form 120 consecutive patients hospitalized for exacerbation heart failure in the cardiology department. 70 patients meet inclusion criteria – Apnea-Hypopnea index (AHI) &gt; 5, Epworth Sleepiness Scale (ESS) &gt; 6, NTproBNP&gt;900 pg/ml, and Body mass index(BMI) &gt;25. All patients receiving optimal medical treatment. The follow-up period was 1 year. The primary endpoint was death for any reason. Sleep apnea screening was performed with ApneaLinkTM. Echocardiographic assessment of left ventricular ejection fraction (LVEF) and the E/e‘m ratio.

Results
From 70 with sleep apnea 73% (n=51) has obstructive sleep apnea (OSA) and 27% (n=19) has central sleep apnea (CSA). Detected significant changes in LVEF between the OSA group and CSA group (EF% 49.7±8.5vs43.3±9.6.4;p=0.008). Statistically significant changes there was about E/e’m ratio (E/e’m-17.01±3.7 vs 19.3±2.73; p=0.015) and BMI (BMI-38.2±6.5 vs 32.2±3.6; p&lt;0.001). We found a moderate reverse correlation between the LVEF and the number of central sleep apnea events (r=-0,34;p=0,003). Simple linear regression was used to test if the left ventricular ejection fraction significantly predicted the number of central apnea events. The overall regression was statistically significant (R2 = 0.120, F(1,68) = 9.26, p = .003). It was found that the left ventricular ejection fraction significantly predicted the number of central apnea events (β = -0.06, p = .003). Patients from both groups were followed up regarding first hospitalization for heart failure and mortality over a period of 12 months. First hospitalization in patients with CSA occurs significantly sooner than in patients with OSA. The average number of months without hospitalization for HF in patients with CSA was 6.7 months versus 9.7 months in patients with OSA (Log Rank (Mental-Cox) p=0.012). The OSA group had a median survival of 10.5 months versus 9.3 months in the CSA group (Log Rank (Mental-Cox) p=0.026).

Conclusion
Sleep apnea is a common comorbidity in patients with exacerbated heart failure and overweight. OSA occurs to a greater extent than CSA. Patients with reduced systolic function are at higher risk of central sleep apneas events. Low LVEF% can be used as a prognostic factor regarding the occurrence of central sleep apnea events. Controlling sleep apnea can reduce patient readmissions and mortality.