bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognoses of “high-profile” diseases: five-year survival following hospitalization with previous cancer compared to previous heart failure
Authors: Fauchier L , Bentounes S A , Bodin A , Bisson A , Herbert J , Genet T , Angoulvant D , Ivanes F 
Published: October 2022

Abstract

Background
The prognostic impact of heart failure relative to that of “high-profile” disease states such as cancer within the whole population is poorly known. Some data reported 2 decades ago indicated that heart failure was as “malignant” as many common types of cancer (with the notable exception of lung cancer) and was associated with a comparable number of expected life-years lost. Whether this is also the case in more recent years is unknown.

Methods
In a nationwide cohort study including 5,123,193 patients seen in French hospitals in 2012 with at least 5 years of follow-up (or dying earlier), all patients with a first admission to any hospital with heart failure or cancer were identified. We assessed the incidence of all-cause death during follow-up (2,523,627person-years). We analysed the outcome for the most common types of cancer specific to men and women and the results were then age-adjusted in men and in women.

Results
In 2012, 409,210 men had a hospitalisation with heart failure (n=164,601) or cancer (n=244,609). Similarly, 325,410 women were admitted with heart failure (n=127,734), or cancer (n=197,676).
Heart failure was associated with a worse survival rate than urologic cancer in men and a worse survival rate than breast cancer, gynaecologic cancer and gastrointestinal cancer in women (Figure 1). On an age-adjusted basis, cancer was associated with a worse survival than heart failure in men except for urologic cancer (see adjusted hazard ratios in Table 1). Cancer was associated with a worse age-adjusted survival than heart failure in women except for breast cancer.

Conclusion
Heart failure may be as “malignant” as many common types of cancer in men and in women. However, it is possible that the prognosis of HF has improved compared to that of cancer in the 2 last decades since only breast cancer in women and urologic cancer in men had a better prognosis than heart failure in an age-adjusted analysis.

Funding Acknowledgement
Type of funding sources: None.
Does a normal electrocardiogram exclude heart failure with reduced left ventricular ejection fraction?
Authors: Auscher S , Mohamed R A , Andersen T R , Overgaard K , Egstrup K 
Published: October 2022

Abstract

Background
In the ESC guidelines for chronic heart failure an electrocardiogram (ECG) is part of the diagnostic set-up (1).
A normal ECG makes the diagnosis unlikely. But can a normal ECG exclude heart failure with reduced left ventricular ejection fraction (HFrEF) and be a gatekeeper to echocardiography?

Methods
Patients referred from primary care to the cardiac outpatient clinic with suspicion of heart failure were consecutively included in the study, during a period of one year. With the referral from primary care was included an ECG which was assessed by a senior cardiologist and divided into two groups: 1) Patients with normal ECG; 2) Patients with pathologically ECG.
Subsequently, an echocardiographic examination was performed in a blinded fashion and left ventricular ejection fraction (LVEF) was measured.

Results
Overall, 403 patients were included in the study. A normal ECG was present in 155 (38%) patients and a pathological ECG was present in 248 (62%) patients. In total, an echocardiographic examination identified 55 (14%) patients with an LVEF below 60% and 33 patients (8%) with LVEF below 50%. In patients with a normal ECG, only two patients had heart failure with a mildly reduced ejection fraction (41–49%), Figure 1.
Thus, the ECG had a sensitivity of 94% and a negative predictive value of 99%, Figure 2.

Conclusion
A normal electrocardiogram has a high diagnostic sensitivity and negative predictive value for excluding heart failure with reduced LVEF and could be a gatekeeping tool in the prioritization of patients referred to echocardiography examination from primary care.

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): Department of Cardiovascular research, OUH, Svendborg Hospital
NT-proBNP is superior to novel plasma biomarkers for predicting adverse outcome in arrhythmogenic right ventricular cardiomyopathy
Authors: Borowiec K , Wozniak O , Wrobel A , Smigielski W , Skrzypczynska-Banasik U , Kowalik E , Lutynska A , Hoffman P , Biernacka E K 
Published: October 2022

Abstract

Background/Introduction
Arrhythmogenic right ventricular cardiomyopathy is a heritable heart muscle disease characterized by progressive substitution of the myocardium with fibrous and fatty tissue, which is the substrate for ventricular arrhythmia, systolic dysfunction and heart failure. Determining the optimal time for heart transplantation is challenging and, therefore, finding risk factors for disease progression is needed.

Purpose
The purpose of the study was to evaluate the role of markers of myocardial fibrosis sST2, Gal-3, MMP-2 and MMP-9, as well as NT-proBNP and hsTnT, in predicting major adverse outcomes in ARVC. Moreover, we aimed to identify other risk factors for developing end-stage heart failure.

Methods
We included 91 patients with the definite diagnosis of ARVC according to the 2010 Task Force Criteria (59 males, mean age of 47±16 years). Patients were interviewed for their medical history, electrocardiography and echocardiography were performed and plasma levels of selected biomarkers were measured. Thereafter, subjects were followed for the occurrence of the composite endpoint of death or heart transplantation (HTx) and major arrhythmic events defined as ventricular fibrillation, sustained ventricular tachycardia or appropriate implantable cardioverter-defibrillator intervention.

Results
During the median follow-up of 36,4 months [29,8–41,2], 13 subjects (14%) reached the composite endpoint of death or HTx and 27 subjects (30%) experienced major arrhythmic event. Among the studied biomarkers, significantly higher levels of sST2, MMP-2, NT-proBNP and hsTnT were found in patients who achieved the composite endpoint. The remaining prognostic factors are shown in Table 1. In the multivariate analysis, three factors turned out to be significant: higher NT-proBNP levels (the cut-off point ≥890.3 pg/m), greater right ventricular end-diastolic area (the cut-off point ≥39.0 cm2) and history of atrial tachycardia. Kaplan-Meyer survival analysis depending on the number of predictors is presented in Figure 1. None of the biomarkers predicted major arrhythmic events.

Conclusions
NT-proBNP ≥890.3 pg/ml, RV area ≥39.0 cm2 and history of atrial tachycardia are independent risk factors for death or HTx in ARVC. Among the studied biomarkers, higher levels of sST2, MMP-2, NT-proBNP and hsTnT were observed in patients who reached the composite endpoint. Biomarkers had no value in predicting ventricular arrhythmias.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): National Institute of Cardiology, Warsaw, Poland
Proenkephalin as a novel prognostic marker in heart failure patients: a meta-analysis
Authors: Siranart N , Laohasurayotin K , Chokesuwattanaskul R , Ariyachaipanich A 
Published: October 2022

Abstract

Background
Proenkephalin (PENK), a novel biomarker, sequentially activates delta-opioid receptors in heart tissue causing reduced myocardial contractility, blood pressure, and heart rate. PENK has several prognostic abilities for patients with myocardial infarction, stroke, and impaired renal function. However, its prognostic value in heart failure patients is still inconclusive.

Purpose
To evaluate the association between plasma PENK level at the time of admission and all-cause mortality in patients with heart failure.

Methods
We collected studies from MEDLINE and EMBASE databases until January 2022 to perform a meta-analysis. High level of PENK is defined as plasma PENK level more than 99th percentile of the general population. Separated pooling hazard ratio (HR) for all-cause mortality among high and normal levels of PENK was performed using a random-effect model, generic inverse variance method of DerSimonian and Laird. Sources of heterogeneity including clinical and methodological variations were explored using a meta regression and subsequent subgroup analysis.

Results
A total of six observational studies composed of 6,929 patients with either acute heart failure or chronic heart failure were included in this analysis. There are five studies involving heart failure patients with both reduced ejection fraction and preserved ejection fraction and another one concerning those with only preserved ejection fraction. High level of PENK was found in 70.9% of patients. The high level of PENK compared with normal levels was associated with a higher prevalence of all-cause mortality with pooled HRs of 1.72 (95% CI, 1.62–1.84; I2=84%). The analyzed data were shown in the Figure 1.

Conclusions
This study demonstrates the association between high levels of PENK and all-cause mortality in heart failure patients. These findings suggest that the opioid system might be involved in deteriorating cardiovascular function in heart failure.

Funding Acknowledgement
Type of funding sources: None.
Selenoprotein-P deficiency is associated with higher risk of incident heart failure
Authors: Jujic A , Molvin J , Schomburg L , Struck J , Bergmann A , Melander O , Magnusson M 
Published: October 2022

Abstract

Background
Selenium deficiency has been associated with all-cause and cardiovascular mortality, incident cardiovascular disease (coronary artery disease, myocardial infarction and stroke), and with poor prognosis in patients with acute heart failure (HF). Furthermore, high selenium levels were recently shown to be associated with reduced mortality and reduced incidence of HF in non-smokers.

Purpose
To examine if selenoprotein-P (SELENOP), a main carrier protein of selenium, is associated with incident HF.

Methods
SELENOP concentrations were measured in 5060 randomly selected subjects from the population-based prospective cohort study “the Malmö Preventive Project” (n=18240) using a validated ELISA approach. After exclusion of subjects with prevalent HF (n=230), complete data on all co-variates was available in 4803 subjects (1400 women (29.1%), mean age 69.6±6.2 years, 885 (19.7%) current smokers). SELENOP was continously related to risk of incident HF using Cox regression models adjusted for age, sex, body mass index, systolic blood pressure, anti-hypertensive treatment, smoking status, diabetes status, low-density lipoprotein cholesterol levels, and prevalent coronary events. Further, subjects within the lowest SELENOP quintile were compared to subjects in the remaining four quintiles in an adjusted model.

Results
Each 1 SD increment in SELENOP levels was associated with lower risk of incident HF (n=436) during a median follow-up period of 14.7 years (interquartile range 10.9–15.7 years, hazard ratio (HR) 0.92, 95% confidence interval (95% CI) 0.84–0.99; p=0.049 in a model adjusted for cardiovascular risk factors. Multivariate quintile analyses revealed that the subjects in the lowest SELENOP quintile were at the highest risk of incident HF in an adjusted model (HR 1.46; 95% CI: 1.17–1.83 for incident HF; p for trend 0.039) illustrated in a Kaplan-Meier survival analysis (Figure 1). No interaction effect was seen for sex or smoking.

Conclusion
Low SELENOP levels are associated with a higher risk of incident HF supporting recent studies, which further emphasizes the need for randomly controlled trials to examine if supplementation with selenium improves prognosis.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Swedish Medical Research CouncilSwedish Society of Medicine
Post systolic shortening by speckle tracking echocardiography as a predictor for cardiovascular events in patients with type 2 diabetes
Authors: Hult L , Kylhammar D , Engvall J , Ostgren C J , Nystrom F , Blomstrand P , Hedman K 
Published: October 2022

Abstract

Background
Post systolic shortening (PSS), measured by speckle tracking echocardiography has emerged as a novel method to evaluate left ventricular function and has been linked to adverse outcomes.

Purpose
Our aim was to assess if the presence of pathological PSS had prognostic value in the prediction of major cardiovascular events in a cohort of patients with type-II diabetes (T2D).

Method
Three-hundred-and-sixty-four patients with T2D in the CARDIPP study (Cardiovascular Risk factors in Patients with Diabetes – a Prospective study in Primary care) underwent echocardiography between 2005 and 2009. All patients were evaluated with strain analysis by speckle tracking. PSS was defined as any myocardial contraction occurring after aortic valve closure (Figure 1). Pathological PSS was defined as a post systolic index (PSI) &gt;5% where PSI was calculated as: (peak global longitudinal strain – peak systolic longitudinal strain) / (peak global longitudinal strain) x 100. The composite endpoint of any major cardiovascular event (MACE) was defined as the diagnosis of or death in heart failure, myocardial infarction, or stroke. Cox proportional hazard ratios (HR) with 95% confidence intervals were calculated and were adjusted for sex, age, body mass index, hypertension, smoking, previous cardiovascular events and HbA1c.

Results
Mean follow-up time was 11.2±2.3 years. Patients with pathological PSS had an increased unadjusted risk of MACE, (HR 3.73, 95% CI 2.06–6.76), which persisted after adjustment (HR 2.20, 95% CI 1.11–4.37) as compared to subjects without pathological PSS. When adding PSS to a risk prediction model including Global Longitudinal Strain (GLS), the adjusted HR (95% CI) for MACE was 2.94 (1.33–6.52) for subjects with reduced GLS (lower limit of normal −16%) and PSI &gt;5%, compared to those with normal GLS and PSI ≤5%. Adverse events were more common in subjects with the combination of pathological PSS and GLS (Figure 2).

Conclusions
Our results suggest that PSS may provide important additional prognostic information in patients with T2D.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This work was funded by grant support from FORSS, the Research Council of Southeastern Sweden and from FUTURUM, the Research Council of Jönköping.
Left atrial reservoir strain and long-term prognosis in patients with heart failure and reduced ejection fraction
Authors: Chimed S , Stassen J , Galloo X , Meucci M C , Van Der Bijl P , Marsan N A , Delgado V , Bax J J 
Published: October 2022

Abstract

Background
Cardiac damage in heart failure (HF) with reduced ejection fraction (HFrEF) often involves structural and functional left atrial (LA) abnormalities. Speckle-tracking echocardiography derived LA reservoir strain (LARS) is a sensitive measurement for early detection of LA dysfunction. However, the prognostic value of LARS is not well established in patients with HFrEF.

Methods
LARS was measured with speckle tracking echocardiography in patients who had a first echocardiographic diagnosis of reduced LVEF (≤45%). Patients with prior history of atrial fibrillation (AF) were excluded. The primary endpoint was newly onset AF, while the composite endpoint of newly onset AF and all-cause mortality was chosen as the secondary endpoint. The study population was divided into two groups according to the optimal threshold value of baseline LARS (derived from spline curve analysis) (Figure 1) and event-free survival rates were compared by the Kaplan-Meier method.

Results
A total of 997 patients (mean age 62±13 years, 73% men) were analyzed. At baseline, LA volume index was significantly larger (41±17 vs. 32±12 ml/m2, p&lt;0.001), and LA reservoir function significantly more impaired (9±3.1 vs. 21±6.3%, p&lt;0.001) in patients with LARS ≤14% compared to patients with LARS &gt;14%. During a median follow-up of 60 months (interquartile range [IQR] 29–60 months), newly onset AF occurred in 75 patients (7.5%), while 254 patients (25.5%) experienced the composite endpoint of newly onset AF and all-cause mortality. The 5-year event-free survival rates for both endpoints were significantly lower in the LARS ≤14% group compared to LARS &gt;14% group (Figure 1A for new onset AF and Figure 2B for the composite endpoint of newly onset AF and all-cause mortality). After adjustment for important risk factors, including HF treatments and echocardiographic predictors, baseline LARS remained independently associated with a higher risk of development of AF (HR=0.89, 95% CI 0.85–0.94, p&lt;0.001) and the composite of newly onset AF and all-cause mortality (HR=0.93, 95% CI 0.91–0.96, p&lt;0.001).

Conclusions
Baseline LARS is associated with long-term prognosis in patients with HFrEF and the association is independent from various clinical and echocardiographic predictors.

Funding Acknowledgement
Type of funding sources: None.
Quantitative estimation of pulmonary artery wedge pressure from chest radiographs by a regression convolutional neural network
Authors: Saito Y , Omae Y , Fukamachi D , Nagashima K , Toyotani J , Okumura Y 
Published: October 2022

Abstract

Introduction
Recent studies reported that a convolutional neural network (CNN; a deep learning model) can detect elevated pulmonary artery wedge pressure (PAWP) from chest radiographs, the diagnostic images most commonly used for assessing pulmonary congestion in heart failure. However, no method has been published for quantitatively estimating PAWP from such radiographs. We hypothesized that a regression CNN, an alternative type of deep learning, could be a useful tool for quantitatively estimating PAWP from chest radiographs in cardiovascular diseases.

Methods
We retrospectively enrolled 936 patients with cardiovascular diseases who had undergone right heart catheterization (RHC) and chest radiography and estimated PAWP by constructing a regression CNN based on the VGG16 model. We randomly categorized 80% of the data as training data (training group, n=748) and 20% as test data (test group, n=188). Moreover, we tuned the learning rate–one of the model parameters–by 5-hold cross-validation of the training group. Correlations between PAWP measured by RHC (ground truth [GT] PAWP) and PAWP derived from the regression CNN (estimated PAWP) were tested. To visualize how the regression CNN assessed the images, we created a regression activation map (RAM), a visualization technique for regression CNN.

Results
Estimated PAWP correlated significantly with GT PAWP in both the training (r=0.76, P&lt;0.001) and test group (r=0.62, P&lt;0.001). Bland-Altman plots found a mean (SEM) difference between GT and estimated PAWP of −0.23 (0.16) mm Hg in the training and −0.05 (0.41) mm Hg in the test group. The RAM showed that our regression CNN model estimated high PAWP by focusing on the cardiomegaly and pulmonary congestion. In the test group, the area under the curve (AUC) for detecting elevated PAWP (≥18 mm Hg) produced by the regression CNN model was similar to the AUC of an experienced cardiologist (0.86 vs 0.83, respectively; P=0.24).

Conclusion
This proof-of-concept study shows that regression CNN can quantitatively estimate PAWP from standard chest radiographs in cardiovascular diseases.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): The Bayer Academic Support
Cardiac magnetic resonance predictors of readmission for heart failure in elderly vs not elderly patients after ST-segment elevation myocardial infarction
Authors: Merenciano-Gonzalez H , Marcos Garces V , Gabaldon-Perez A , Gavara J , Lopez-Lereu M P , Monmeneu J V , Perez N , Rios-Navarro C , De Dios E , Chorro F J , Valente F , Lorenzatti D , Ortiz-Perez J T , Rodriguez-Palomares J F , Bodi V 
Published: October 2022

Abstract

Background
Patients with ST-segment elevation acute myocardial infarction (STEMI) have an increased risk of re-admission for acute heart failure (AHF). However, identification of patients at higher risk of AHF is challenging, especially in elderly individuals. The implications of cardiac magnetic resonance (CMR) imaging soon after the acute event for this specific purpose are unknown.

Purpose
We aim to study the clinical and CMR predictors of AHF in elderly and not elderly patients after STEMI.

Methods
STEMI patients treated with percutaneous coronary intervention and discharged from three university hospitals were included in a multicenter registry. We registered baseline clinical characteristics, echocardiographic parameters and early (1-week) CMR parameters - left ventricular ejection fraction (LVEF, %), infarct size (% of left ventricular mass) and microvascular obstruction (MVO, number of segments). Univariate and multivariate comparisons were performed in elderly (&gt;70 years) and not elderly (≤70 years) patients to predict AHF during follow-up.

Results
The cohort was comprised of 759 patients, of which 177 (23.3%) were elderly (&gt;70 years). During a mean follow-up of 5.23±3.54 years, 79 (10.4%) patients presented AHF. In not elderly patients, Killip class at admission (HR 2.05 [1.32–3.17], p=0.001), anterior infarction (HR 3.43 [1.13–10.36], p=0.03) and CMR-LVEF (HR 0.94 [0.91–0.98] per increased %, p=0.001) independently predicted AHF. However, a combined risk score comprising these variables was not superior to CMR-LVEF alone to predict AHF during follow-up (AUC 0.81 [0.74–0.88] vs. 0.81 [0.73–0.88], p=NS). In elderly patients, CMR-LVEF was the only predictor of AHF in the final multivariable model (HR 0.94 [0.91–0.97], p&lt;0.001), although its predictive power was moderate (AUC 0.68 [0.56–0.80], p=0.001). Most AHF events in the not elderly subgroup occurred in patients with reduced (≤40%) CMR-LVEF (71%), while in the elderly subgroup AHF occurred more frequently in patients with preserved (≥50%, 30%) or mildly reduced (40–49%, 32%) CMR-LVEF than reduced (≤40%) CMR-LVEF (38%).

Conclusions
LVEF quantified by CMR soon after STEMI can accurately predict the risk of AHF in not elderly (≤70 years) patients and identify those individuals at higher risk (i.e. CMR-LVEF ≤40%). However, in elderly (&gt;70 years) patients most AHF occur in patients with CMR-LVEF &gt;40%, emphasizing the need for better predictive strategies in this population.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding. Main funding source(s): Instituto de Salud Carlos III and “Fondos Europeos de Desarrollo Regional FEDER” and Conselleria de Educaciόn – Generalitat Valenciana.