bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of nutritional status in post-implant CRT outcomes in patients with chronic heart failure
Authors: Brochado L , Santos E , Rosas F , Brandao M , Manuel A M , Almeira J G , Goncalves H , Oliveira M , Primo J G , Fonseca P , Fontes-Carvalho R , Leite-Moreira A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
There’s a close relationship between chronic heart failure (CHF) and malnutrition, and their main pathophysiological modifications are well known. Cardiac resynchronization therapy (CRT) has proven to be a promising therapy in symptomatic heart failure (HF) patients with broad QRS complexes and impaired systolic function with optimized medical therapy. However, there is still a considerable amount of non-responder patients. The role of nutritional status in CRT therapy response has yet still not been well assessed.

Purpose
Assess the prognostic value of nutritional status in post-op outcomes in patients with Chronic Heart Failure and (CRT)

Methods
Single-center retrospective study of patients submitted to CRT implantation between January 2007 and march 2021. Inclusion criteria were patients meeting criteria for CRT implantation, QRS duration ≥ 120ms, FEVE ≤ 35%, NYHA class II–IV and no adverse events during the follow up. Primary outcomes measured were all-cause mortality, cardiovascular mortality, and hospitalizations due to HF in a 1-year follow-up. To evaluate patient's nutritional status the CONUT score was used with patients being categorized in 2 groups: Low CONUT (Score 0-4: normal/low malnutrition) and Hight CONUT (Score 5-12: moderate/severe malnutrition).

Results
198 patients (83%) exhibited Low CONUT status, and 41 patients (17%) exhibited High CONUT status. Patients with Hight CONUT were older (72.9 yrs vs 65.9 yrs, p&lt;0.001), and exhibited higher percentage of chronic obstructive pulmonary disease (43.9% vs 27.3%, p=0.004), atrial fibrillation (72.9%, vs 25.3%, p&lt;0.001), hypertension (78.1% vs 60.6%, p=0.038), chronic kidney disease (39.1% vs 21.2%, p=0.016) and NYHA IV (19.5% vs 5.1%, p&lt;0.001). Cardiovascular mortality was 3.7% in the low CONUT group vs 29.3% in the Hight CONUT group (p&lt;0.001; HR, 0.12; 95% CI, 0.05-0.29) and total HF hospitalizations were 16 and43, respectively (p=0.013; HR, 0.482, 95% CI, 0.27 to 0.86). The nutritional status prior to CRT assessed by the CONUT score showed to be an independent predictor of cardiovascular mortality (p=0.007; HR, 0.16 95% CI, 0.04-0,60).

Conclusion
Malnutrition was a common condition in our CRT patients showing that deficient nutrition status remains highly underdiagnosed. Patients with worse nutritional status before CRT device implantation presented higher morbidity and were more prone to worst outcomes such as cardiovascular mortality and mortality by all causes as well as higher incidence of hospitalizations secondary to HF decompensation. Assessment of nutritional status using screening tools may provide additional prognostic information in patients with HF and help early identification of those who may benefit from further assessment and nutritional intervention.
Effects on the timing of left ventricular pressure rise when pacing the right ventricular free wall in cardiac resynchronization therapy
Authors: Marciniak M , Albatat M , Hammersboen L E , Stugaard M , Frostelid V C , Finstad E , Remme E , Odland H 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Norwegian Research Council.

Background/Introduction
The timing of left ventricular pressure rise (Td) is associated with dispersion of regional work distribution and prolongs with dyssynchrony and dyssynergistic contractions. Synergistic contractions shorten Td and result from effective biventricular pacing (BIVP). Attempts have been made to optimize right ventricular (RV) lead position with septal lead placement away from the apex. In this study we attempted to study the effects from RV free wall (RVfw) compared to septal/ apical RV (RVsept) lead positioning on Td.

Purpose
RVfw pacing results in activation of RVfw before LV activation with a delay that may hamper the myocardial synergy resulting from biventricular pacing. This effect has not yet been demonstrated and may play an important role to understand non-response to CRT.

Methods
9 mongrel dogs were included in the study and handled according to ethics committee approved protocol/GLP. Pacing electrodes were placed epicardial on the left atrial appendage, the RVfw and LV, and endocardial in the septum. Pressure was measured with a Micro-tip pressure sensor (Millar Inc.) in the LV. BIVP was performed from LV combined with RVsept or RVfw. Td was measured from 10 consecutive beats. Mixed models were utilized for the repeated measurements.

Results
The average Td with BiVP-RVfw, BIVP-RVsept and LV pacing only was 116ms (95% CI: 110, 122), 114ms (95% CI: 108, 120), and 118ms (95% CI: 112, 124) respectively (p&lt;0.001). BiVP with RVsept shortened Td by 4.1 ms (95% confidence interval (CI): -5.3, -2.9, p&lt;0.001), whereas BiVP with RVfw pacing location shorten Td by 1.8 ms (95% CI: -2.8, -0.8, p&lt;0.001), compared to LVP. The SD from 10 beats was on average 0.8ms (range 0-1.6ms).

Conclusion(s)
Myocardial Synergy with shortening of Td compared to LV only pacing was demonstrated with BIVP regardless of RV position. The synergistic effect from BIVP is more pronounced with BIVP-RVsept than from BIVP-RVfw. RV lead position may play an important role in cardiac resynchronization therapy that can be revealed when measuring the time-course of LV pressure rise.
Short term outcome of different lower pacing rates in patients with recently implanted CRT
Authors: Ragab A H M E D , Abdelwahab A M I R , Hassanien N O H A , Sharaf Y A S S E R , Eldamaty A H M E D 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac Resynchronization Therapy (CRT) is a well-established treatment for patients with congestive heart failure, impaired ejection fraction and QRS duration more than 130 msec. Around one third of patients remains to be non-responders. Several parameters have been tested aiming at improving the response rate.

Purpose
We aim at comparing the effect of two bi-ventricularly base pacing rates (DDD 60 Bpm vs DDD 80 Bpm) on the composite endpoint of mortality and hospitalization due to heart failure.

Methods
We included patients with recently implanted CRT, all patients had LBBB, QRS duration more than 130 msec and ejection fraction less than 35%. Patients were randomized using randomization table into two groups (DDD 60 bpm and DDD 80 bpm). Patients with atrial fibrillation, active coronary artery disease and those who refused to sign a consent were excluded from the study. Patients were followed 3 months after randomization and then every 6 months thereafter.
CRT programming was done, the following pacing parameters were standardized for all patients as per protocol: Mode of pacing was set at DDD, sensor was set as passive, VV delay at 0msec, sensed AV delay at 120ms and paced AV delay at 150ms. Dynamic AV and VV delay optimization algorithms were intentionally turned off.

Results
Fifty-one patients were enrolled, 45 patients were included in the final analysis (one died before the randomization, two patients were excluded due to average heart more than 80 beats/min at the time of randomization and three were lost to follow up). Mean age was 51.67 ± 11.1 years, 23 patients (51.1%) were females. Thirty-seven patients (82.2%) had dilated Cardiomyopathy, 16 patients (35.6%) had New York heart association (NYHA) functional class (FC) III heart failure (HF) and 29 patients (64.4%) had NYHA class IV (ambulant) HF. At baseline, Minnesota living with heart failure questionnaire score was (52.56 ± 14.3), six minutes-walk distance was 242 ± 95.9 meters and EF was 24.6± 7.4%. Patients were followed for mean duration of 23.2 ± 11.5 months. More patients reached the primary endpoint of death or hospitalization due to heart failure in the DDD 80 bpm group [ 3 (13.6%) vs 13 (56.5%), P=0.003]. This was driven mainly by hospitalization due to heart failure. Death was numerically higher in the DDD 80 group but this was not statistically significant [1 (4.5%) vs 4 (17.4%), P=0.18]. Patients in DDD 60 group had significant improvement in the 6MWD, NYHA functional class, EF % and Minnesota living with heart failure score compared to non-significant improvement in the DDD 80 group. (Table 1)

Conclusions
In CRT recipients, Base pacing rate 60 beats/min shows less incidence of the composite endpoint of mortality and hospitalization due to heart failure and base pacing rate 80 beats/min could potentially be harmful.
Appropriate and inappropriate therapies in remotely monitored patients with cardiac implantable devices long-term experiences of a tertiary centre
Authors: Dyrbus M , Pyka L , Kurek A , Niedziela J T , Adamowicz E , Ostrega M , Sokola K , Pres D , Gasior M , Tajstra M 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The evidence supporting the implantation of implantable cardioverter-defibrillator (ICD) in the primary prevention of sudden cardiac death (SCD) comes mostly from the times when optimal management of heart failure was not as effective as at present. Moreover, the detailed data on the long-term risk of arrhythmias in patients with ICD are scarce.

Purpose
To present the long-term results of the remote monitoring (RM) of patients with ICD from a large, tertiary cardiovascular centre registry.

Methods
The clinical data from the time of device implantation were derived from the COMMIT-HF registry, while the follow-up data were obtained from the investigator-initiated RM registry. In brief, the registry encompasses data regarding the types of the transmissions and their contents, with particular emphasis on the occurrence of arrhythmic episodes, device interventions, as well as the data on the causes of other alert transmissions.

Results
In total, 1,299 patients were included in the analysis. The median follow-up duration of RM was 4.4 years, and the primary indication for implantation was ischemic cardiomyopathy (60.3%). Appropriate antitachycardia pacing (ATP) and high-voltage therapy for ventricular arrhythmias occurred in respectively 25.3% and 26.1% of patients, while inappropriate ATP and HV in respectively 11.5% and 8.7%. The prevalence of AF was 40.8%.

Conclusions
In a large real-life cohort of continuously remotely monitored patients with ICDs, the percentage of patients with appropriate therapies for ventricular arrhythmias exceeded 25%. Further analyses are necessary to stratify the risk of ventricular arrhythmias in the contemporary practice.
Leadless pacemaker implantation following transvenous lead extraction: data from i-LEAPER registry
Authors: Mitacchione G , Schiavone M , Arabia G , Gasperetti A , Mazzone P , Rovaris G , Dello Russo A , Biffi M , Pisano E , Della Bella P , De Asmundis C , Saguner A , Tondo C , Curnis A , Forleo G B 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
transvenous (TV) pacemakers are negatively associated with local and systemic device-related infections, often requiring transvenous lead extraction (TLE). Moreover, patients reimplanted with a TV device following TLE, exhibit substantial mortality and reinfection rates during the subsequent follow-up (FU). In this setting, leadless pacemakers (LPMs) are appealing as a first choice for TLE patients requiring a pacemaker reimplantation. To date, limited data on real-world safety and efficacy of LPMs in patients who underwent TLE are available.

Purpose
The present study aims to assess long-term safety and efficacy of LPM implantation in patients who previously underwent TLE of a transvenous pacemaker, compared to LPM de novo implant patients.

Methods
Consecutive patients who underwent LPM implantation in 12 centers joining the International LEAdless PacemakEr (i-LEAPER) registry were enrolled. Patients receiving LPM following TLE (n=184) were compared with patients with de novo implant (n=995). The primary endpoint was LPM-related major complications rate at implant and during FU. Additionally, differences in electrical performance were assessed between the two groups. Completion of 12-months FU was obtained in all patients.

Results
1179 patients were enrolled in this study and followed for a median of 12 [IQR 11-14] months. Baseline clinical characteristics resulted balanced among the two groups, apart from a higher prevalence of heart failure among recipients of LPM following TLE (16.8% vs. 9.4%, p=0.013). As reported in the Table, LPM related major complications and all-cause mortality did not differ among the two groups (1.6% TLE group vs. 2.2% de novo group, p=0.785, and 5.4% TLE group vs. 7.8% de novo group, p=0.288, respectively). Pacing threshold (PT) resulted higher in the TLE group throughout the FU (Figure-Panel A). Higher PTs were recorded in LPMs implanted at same location from where the previous transvenous lead was removed, as far as 12-months postimplant (Figure-Panel B), with a higher proportion of patients with high PT (&gt;1 to 2V @0.24ms) in the first group at implant, 1-month, and 12-month FU (Figure-Panel C).

Conclusion
In this real-world registry, LPMs showed a satisfactory safety and efficacy profile after TLE. In the post-TLE cohort, better electrical parameters were obtained when LPMs were implanted at a different location from where the previous transvenous lead was extracted.
Procedural outcome and risk prediction in young patients undergoing transvenous lead extraction. A GALLERY subgroup analysis
Authors: Chung D , Rexha E , Pecha S , Burger H , Naegele H , Reichenspurner H , Gessler N , Willems S , Butter C , Hakmi S 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
The prevalence of young patients with cardiac implantable electronic devices (CIED) is continuously rising. Along with this development there is a concomitant increase in the incidence of CIED-related complications, such as device-related infections and lead failure. Transvenous lead extraction (TLE) has evolved into an indispensable therapeutic option for such cases.

Aim
The aim of this study was to analyze patient characteristics and procedural outcomes of young patients undergoing TLE and to identify independent risk factors for adverse events.

Methods
We performed a subgroup analysis of all patients in the GALLERY (GermAn Laser Lead Extraction RegistrY) who were 45 years or younger at the time of enrollment. Predictor variables for all-cause mortality, procedural complications and procedural failure were assessed via multivariate analyses.

Results
We identified 160 patients (6.3% of the GALLERY) aged 45 years or younger with a mean age of 35.3±7.6 years and 42.5% (n=68) female patients. Mean body mass index was 25.6±5.4 kg/m2 and the proportion of patient with highly reduced ejection fraction (LVEF &lt;30%) was 11.3%. Comorbidities, such as arterial hypertension (AHT), diabetes mellitus (DM) and chronic kidney disease (CKD) were present in 23.8%, 6.3% and 5.0% of patients, respectively. Leading extraction indication was lead dysfunction in 51.3% of cases, followed by local infections in 20.6% and systemic infections in 16.9%. The most common device to be extracted were implantable cardioverter-defibrillators (ICD) with 52.5%. Mean number of leads per patient was 2.2±1.0. Median age of the oldest indwelling lead was 91.5 [54.75-137.5] months. Median procedural time was 88 [65-151.75] minutes. Overall complication rate was 3.8% with 1.9% minor and 1.9% major complications. Complete procedural success was achieved in 90.6% of cases. Clinical procedural success rate was 98.1%. Procedure-related mortality was 0.0%. All-cause in-hospital mortality was 2.5%, which was mainly due to septic shock. Multivariate analysis revealed CKD as independent predictor for all-cause mortality (OR: 51.48; 95% CI: 1.98-1340.0; p=0.018). Lead age ≥10 years (OR: 14.58, 95% CI: 1.36-156.2; p=0.027) was identified as sole independent risk factor for procedural complication.

Conclusion
Transvenous lead extraction in young patients is safe and effective with a procedure-related mortality rate of 0.0%. All-cause mortality was mainly driven by patients succumbing to CIED-related sepsis, despite successful extraction. Chronic kidney disease and lead age ≥10 years are relevant risk factors in young patients undergoing TLE.
Self-taught ultrasound-guided axillary vein access for pacemaker implantations - complication rates and outcomes
Authors: Kong Q G , Ang D T Y , Peat E , Hood S , Lau Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiac implantable electronic devices (CIEDs) are the mainstream therapy for advanced atrioventricular block or sustained ventricular arrhythmia. EHRA survey (1) showed that cephalic vein dissection and blind subclavian vein puncture are the preferred techniques for the implantation of CIED leads in European centres. Ultrasound (US) guided axillary puncture has emerged as feasible alternative for safe and rapid venous access for lead implantation. However, insufficient evidence to support its widespread adoption.

Aim
To compare the complication rates and clinical outcomes of CIED implantations utilising self-taught US guided axillary puncture versus non-US guided venous access (Subclavian puncture and fluroscopy guided axillary puncture). Assess the mean time to gain venous access and overall success rate in US guided technique.

Methods
Retrospective , observational study across two sites involving all CIED implantations of four experienced implanters over the year from January 2021 - June 2022. Patient's demographics, venous access time, complications and clinical outcomes were extracted from electronic database. US axillary access technique was self-taught.

Results and Outcomes
Venous access was obtained by US Guided axillary puncture in 146 patients, non-US guided in 208 patients. Successful axillary venous access by ultrasound guidance is 97%(146/151) with mean time to venous access of 2.1 minutes.
Baseline demographics (age, gender) and comorbidities (hypertension, diabetes, cardiomyopathy, coronary artery disease, dyslipidemia, renal failure, oral steroid use, nicotine use) were similar between both US-guide and non-US guided groups, usage of oral anticoagulations (32.9% vs 39.4%,p=0.208) and antiplatelet agents(28.1% vs 35.1%,p=0.164) were not statistically different.
Greater proportion of dual chamber pacemakers were implanted in US guided access group versus non-US guided (39.7% vs 27.9%,p=0.015).
US Guided axillary access resulted in lower overall complication rate (2.1% vs 8.9%, p=0.0196): lower risk of pneumothorax (0% vs 3.8%,p=0.0236), lower risk of haemathoma (0% vs 3.4%,p=0.0448). No difference in short term pocket/lead infection or lead displacement. Severe vascular complications remains low in both groups.
Stepwise binary regression analysis demonstrated US guidance as independent predictor of lower overall complication rate, odd-ratio 0.195 (95% CI 0.054 - 0.706).
Summary: This multi-centered, retospective observational study demonstrated that US guided axillary access has high overall success rate, not time consuming and resulted in lower complication rates (especially pneumothorax and pocket haemathoma), despite the US access technique being self-taught and have greater proportion of dual chamber device implantations. US guided axillary access is demonstrated to be independently associated with 5-fold lower risk of complications.
A data-driven cluster analysis of stroke phenotypes in Asian patients with atrial fibrillation: refinement of the CHA2DS2-VASc score
Authors: Hsu J C , Yang Y Y , Chung S L , Lin L Y 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Introduction
Atrial fibrillation (AF) is a disease with heterogeneous underlying conditions which usually encompass several cardiovascular comorbidities. There is a lack of large studies investigating the heterogeneity of patients with AF in Asian population. A refined classification may contribute on individual precise treatment and prognosis.

Methods
This cohort study was conducted utilizing a database from a tertiary medical center. Between 2014 and 2019, a total of 5002 adult patients with AF were enrolled for analysis. We performed an unsupervised hierarchical cluster analysis based on CHA2DS2-VASc score after model assessment. The risk of transient ischemia accident (TIA)/ischemic stroke, heart failure (HF) hospitalization, cardiovascular mortality, and all-cause mortality were assessed.

Results
We identified four replicable distinct clusters of patients with AF: cluster I included diabetic patients with HF with preserved ejection fraction and chronic kidney disease; cluster II included elder patients with a low BMI and pulmonary hypertension; cluster III included patients with metabolic syndrome and atherosclerotic disease; and cluster IV included patients with left heart dysfunction including reduced ejection fraction and enlarged left atrium. The incidence of stroke were 12.7%, 15.1%, 9.9%, and 6.3% in clusters I to IV respectively. Cox regression analyses showed that the differences in risk of TIA/ischemic stroke risk across clusters (cluster I, II, III vs. IV) were statistically significant (Hazard ratio (HR) 1.87 [95% CI 1.00–3.48], 2.06 [95% CI 1.06–4.01], 1.70 [95% CI 1.02–2.84]). Cluster II was independently associated with highest risk for stroke (HR 2.06 [1.06-4.01]), HF hospitalization (HR 1.19 [95% CI 0.79-1.80]), cardiac death (HR 2.51 [95% CI 1.21-5.22]), and all-cause death (HR 2.98 [95% CI 1.98-4.50]).

Conclusion
The study indicated the feasibility of clinical application of the cluster analysis in a highly heterogeneous cohort of patients with AF after accounting for CHA2DS2-VASc risk scores. Patients can be divided into four phenotypes with distinct patient characteristics and cardiovascular outcomes.