bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic impact of the serial change of a systemic inflammation-nutrition index in patients with heart failure with preserved ejection fraction: insights from pursuit-hfpef registry
Authors: Sakamoto D , Seo M , Yamada T , Yano M , Hayashi T , Yasumura Y , Hikoso S , Sotomi Y , Sakata Y 
Published: October 2022

Abstract

Background
Malnutrition and inflammation are associated with poor outcomes with heart failure (HF). It has been reported that advanced lung cancer inflammation index (ALI), calculated by body mass index × serum albumin level / neutrophil to lymphocyte ratio (NLR) can be useful for the risk stratification and predicting the post-discharge prognosis of the patients with acute decompensated heart failure (ADHF). However, there is no information available on the prognostic value of the serial ALI change in ADHF patients with preserved ejection fraction (HFpEF).

Methods and results
Patients' data were extracted from The Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT HFpEF) study, which is a prospective multicenter observational registry for ADHF-HFpEF in Osaka. Laboratory data and body weight measurements were performed at the discharge and 1 year after the discharge. We analyzed 527 patients after exclusion of patients on dialysis, in-hospital death, missing follow-up data, or missing data to calculate ALI. The study patients were categorized by the serial change from baseline to 1 year after the discharge (ΔALI) as follows: low tertile: ΔALI &lt;−6.99 (n=176), middle tertile: −6.99 ≤ ALI &lt;8.44 (n=176), and high tertile: 8.44 ≤ ΔALI (n=175). The endpoints of the present study were all-cause death (ACD) and cardiovascular death (CVD). During a mean follow-up period of 1.5±1.0 years, 94 patients had ACD and 40 patients had CVD. The Kaplan-Meier analysis revealed that the patients with middle and low ΔALI at 1 year after heart failure hospitalization had a significantly greater risk of reaching the ACD and CVD than those with high ΔALI (ACD: 22% vs 22% vs 10%, p=0.0011, CVD: 10% vs 9% vs 3%, p=0.014). On multivariate Cox analysis, ΔALI was significantly associated with ACD independently of age, gender, serum NT-proBNP level, and baseline ALI after adjustment for NYHA functional class, serum creatinine level, serum hemoglobin level, serum CRP level, serum sodium level and LVEF.

Conclusion
This study showed that patients with the increased ALI after the discharge had improved outcome in comparison to those without the increased ALI. The serial change of ALI, a systemic inflammation-nutrition index, might be useful for stratifying ADHF patients with HFpEF at risk for the total mortality and cardiovascular mortality.

Funding Acknowledgement
Type of funding sources: None.
Sex versus gender-related differences in new-onset heart failure with preserved and reduced left ventricular ejection fraction
Authors: Qin H , Santema B T , Emmens J E , Van Essen B J , Gansevoort R T , Bakker S J L , De Boer R A , Voors A A 
Published: October 2022

Abstract

Aims
Sex refers to genetic and biological characteristics, whereas gender reflects psychosocial norms, roles and behaviors. Sex differences in new-onset heart failure are well described, but gender differences in new-onset heart failure with preserved (HFpEF) and reduced left ventricular ejection fraction (HFrEF) are unknown.

Methods
A total of 6830 participants (50.3% women, mean age of 54 years) from the Prevention of Renal and Vascular End-Stage Disease (PREVEND) observational Dutch cohort were enrolled in the study. Gender-related characteristics were assessed using self-administered questionnaires. LASSO regression analysis selected the psychosocial variables related to sex, whose coefficient estimates were used to calculate the gender-related scores for each subject [1–2]. The participants were grouped by sex and further analyzed according to tertiles of the gender-related score. Competing-risk regression analysis was used to assess whether sex and gender were associated with new-onset HFrEF (LVEF ≤40%) and HFpEF (LVEF ≥50%).

Results
Women with predominantly masculine gender had lower BMI, were more often Caucasian and had higher total cholesterol and high-density lipoprotein (HDL) levels than women with a predominantly feminine gender. Men with predominantly feminine gender were less often Caucasian with lower total cholesterol and HDL cholesterol levels than men with a predominantly masculine gender. During a median follow-up of 8.3 years, 227 (3.3%) subjects were diagnosed with heart failure (57.3% HFrEF and 43.7% HFpEF). In the total population including both men and women, feminine gender was significantly and independently associated with a higher risk of new-onset HFpEF compared with masculine gender (HR per 10 point: 1.17, 95% CI: 1.06–1.30; p=0.003). However, sex was not associated with new-onset HFpEF (HR: 1.09, 95% CI: 0.73–1.62; p=0.670). Separately in men, feminine gender was associated with a higher risk of new-onset HFpEF (HR: 1.37, 95% CI: 1.06–1.78; p=0.017), but not in women (HR: 1.13, 95% CI: 0.90–1.41; p=0.310).

Conclusions
Gender and sex are different constructs and feminine gender was associated with an increased risk of new-onset HFpEF, whereas sex was not associated with new-onset HFpEF.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Dutch Kidney Foundation
Sex-related differences in long-term outcome of heart failure in low-risk patients with atrial fibrillation. A Swedish registry case-control study
Authors: Basic C , Hansson P O , Zverkova Sandstrom T , Johansson B , Fu M , Mandalenakis Z 
Published: October 2022

Abstract

Background
Knowledge about sex-related differences regarding long-term risk of heart failure (HF) among patients with atrial fibrillation (AF) is limited.

Aim
To evaluate the impact of sex on risks for new onset HF in patients with AF.

Methods
All patients from the Swedish National Patient Register, with a first-time diagnosis of AF between 1987 and 2018 were identified and compared with two matched controls without AF from the Total Population Register. Patients &lt;18 years, or any previous cardiovascular disease, diabetes mellitus and renal failure at the baseline were excluded.

Results
In total 227,811 patients and 452,712 controls were included; 44.5% were women. The mean age (SD) for men was 65.5 (15) vs. 72.7 (13) in women (p&lt;0.0001). The incidence rate for HF onset per 1000 person-years within one and five years after AF diagnosis was 77.3 (75.5–79.1) and 45.0 (44.3–45.7) in women vs. 66.5 (65.0–68.0) and 35.3 (34.8–35.9) in men, respectively. The incidence rate for HF onset increased with age in both patients with AF and controls, but was generally more pronounced in women. Women had 26% and 34% higher risk for HF onset, within five and thirty years, respectively. The highest risk for HF onset was found in women 18–34 years and 35–49 years of age, HR 24.64 (95%, confidence interval (CI) 7.59–80.0) and 8.09 (95%, CI 6.34–10.33) vs. 9.86 (95%, CI 6.81–14.27) and 6.52 (95%, CI 5.87–7.25) in equally old men. The mortality rate after HF was 42.3% and 33.1% in women and men with AF (p&lt;0.0001).

Conclusion
In this nationwide, register-based cohort study, when compared to matched controls we found that the risk for HF onset was higher in women with AF, particularly in reproductive age, highlighting great importance of further research for prevention of HF in young women with AF but without any other cardiovascular risk factors.

Funding Acknowledgement
Type of funding sources: None.
The HFFI, a new frailty index for assessing long-term outcomes in heart failure
Authors: Santos J , Neto V , Correia J , Ferreira G , Correia E 
Published: October 2022

Abstract

Introduction
Patients hospitalized due to heart failure (HF) compose a heterogeneous population whose prognosis is difficult to forecast. Frailty is a well-recognized prognostic marker in multiple chronic diseases, including HF; however, frailty evaluation is often subjective and standardized and objective prediction models are lacking. We aimed to evaluate if an objective and simple index – Heart Failure Frailty Index (HFFI)– can predict long-term outcomes in this population.

Methods
A retrospective analysis of 258 patients admitted to a Cardiology ward due to HF was performed. The variables albumin, C-reactive protein levels, age and body mass index (BMI) were selected for frailty assessment. After attributing points for each variable, according to odds ratio on univariate analysis, the HFFI was calculated (range 0–8), resulting from the sum of the points attributed to each variable. Kaplan-Meyer and Cox-regression analysis were performed to evaluate HFFI association with 24-month mortality (24MM) and 24-month composite endpoint of rehospitalization or death (24MH).

Results
Mean patient age was 75 (±11) years; 51% were men. 45.7% had atrial fibrillation, 15.9% hat history of acute myocardial infarction, 67.8% had hypertension. Mean LVEF was 47% (±17). A LVEF &lt;40% was present in 40% of patients. 24MM was 11.5% and 24 MH was 58%. Patients were considered frail if they had an HFFI ≥3. Kaplan-Meyer curve analysis revealed a significantly lower median time to 24MM in frail patients, as assessed by HFFI, comparing to non-frail patients (585±33 days vs 697±12 days, mortality rate: 25.4% vs 5.7%, χ2=18.156, p&lt;0.001). There was also a significantly lower median time to 24MH in frail patients (336±34 days vs 449±24 days, combined endpoint rate: 76.1% vs 50.3%, χ2=10.884, p=0.001). Cox regression analysis demonstrated that HFFI independently predicts 24MM (HR: 1.364, p=0.002) and 24MH (HR: 1.106, p=0.035), even after adjustment for other prognostic markers, such as history of atrial fibrillation, previous myocardial infarction, diabetes and natriuretic peptides serum level at index event.

Conclusion
HFFI is a simple and objective frailty index correlated with 24MM and 24MH, being an independent prognostic marker in this population. Its use may help to identify patients with a high risk of mortality or readmission, in need of specialized care.

Funding Acknowledgement
Type of funding sources: None.
Ten year survival after an acute heart failure episode
Authors: Carreira M , Madureira S , Neves A , Elias C , Ribeirinho-Soares J P , Pereira J , Amorim M , Lourenco P 
Published: October 2022

Abstract

Background
Heart failure (HF) hospitalizations foreshadow a very gloomy outcome. In the first 3 months, the vulnerable period, mortality is around 10% and 28% of patients die in the first-year post hospitalization. Reports on 10-year survival are scarce.

Purpose
We assessed the 10-year survival rate in a 21st century cohort of acute HF patients and studied survival predictors.

Methods
We studied a cohort of HF patients that were included in an acute HF registry between March 2009 and December 2010. All patients hospitalized in the Internal Medicine Ward with the primary diagnosis of acute HF were eligible. Both patients with left ventricular systolic dysfunction and those with HF with preserved ejection fraction were included. As part of the registries protocol all patients had a complete examination and a venous blood sample collection both at admission and discharge. Patients were followed up to 10 years and all-cause mortality was the endpoint under analysis. A multivariate Cox-regression model was used to assess variables independently associated with 10-year death. A Receiver operator characteristic (ROC) curve was used to choose the best brain natriuretic peptide (BNP) cut-off for mortality prediction.

Results
A total of 591 patients surviving an HF decompensation episode were included in the analysis. Mean age was 76 (±12) years, 44.8% were male and 37.9% had preserved ejection fraction. Comorbidity burden was high: 76.6% had arterial hypertension and 50.6% had diabetes. Only 69 (11.7%) patients were alive 10-years post discharge. Survivors were younger (63 vs 78 years), less often presented diabetes, they had higher haemoglobin and albumin levels, better renal function and lower BNP and uric acid levels. Independent predictors of 10-year mortality were higher BNP, increasing age, lower albumin and atrial fibrillation. The area under the ROC curve for the association of BNP with 10-year death was of 0.71 (0.65–0.77), p&lt;0.001. The best BNP cut-off for 10-year mortality prediction was 800pg/mL with a sensitivity of 50.4%, specificity=85.3%, positive predictive value (PPV) =96.3% and negative predictive value (NPV) of 18.6%. Patients with BNP≥800pg/mL have 96.6% probability of dying in the upcoming 10-years, and a HR of 1.95 (1.60–2.38), p&lt;0.001 than those with lower values. Using a discharge BNP cut-off of 50pg/mL the negative predictive value is 66.0% and a PPV is 89.9% of being dead at 10-years. The PPV of dying in the upcoming 10-years was of 100% for patients with discharge BNP≥1864pg/mL.

Conclusions
The ten year survival rate of a real-world acute HF population was of 11.7%. The variables more strongly associated with 10-year mortality were higher BNP and age. Patients discharged with BNP ≥800pg/mL have 2-fold higher risk of dying in the upcoming 10 years than the remaining. All patients discharged with BNP ≥1864pg/mL were dead 10-years later.

Funding Acknowledgement
Type of funding sources: None.
Incidence and mortality of women diagnosed with peripartum cardiomyopathy from 1997 to 2019 in Sweden, national registry-based study
Authors: Basic C , Schaufelberger M , Svanvik T , Thunstrom E 
Published: October 2022

Abstract

Background
Data from previous studies indicate on increase in incidence of cardiomyopathies in Sweden. Another study confirmed high validity of diagnosis cardiomyopathy in western Sweden suggesting that a real increase in cardiomyopathy diagnosis might have occurred. Peripartum cardiomyopathy is a potentially dangerous condition that occurs few months before or up to five months after delivery.

Purpose
To assess incidence and mortality rates of women diagnosed with PPCM over last two decades in Sweden.

Methods
All women 18 to 50 years of age registered in the National Patient Register (NPR) in the period 1st January 1997 to 31st December 2019 were included. With the use of personal identification number (PIN), the data was than linked to other registers. Data on pregnancies were obtained from the Swedish Medical Birth Register (MBR) and data on the time of death and causes of death were gained from the Cause of Death Register. Women with PPCM were identified in the NPR using the international classification code for disease ICD-10 codes 090.3 as well as other coexisting conditions. The observation time was divided into fallowing periods: 1997–2001, 2002–2004, 2005–2007, 2008–2010, 2011–2013, 2014–2016 and 2017–2019.

Results
In total, over the period of 23 years we identified 2376988 deliveries. There were 23 women diagnosed with PPCM. The prevalence of women who received the diagnostic code for PPCM increased over time from 0.003% in the first time period to 0.012% in the last time period (Figure 1). In total 4.5% of women diagnosed with PPCM died during the observation time.

Conclusion
In this national, register-based study 187 women had diagnose PPCM. Total mortality over twenty years of time was low. Worryingly, we observed a four-fold increase in the use of diagnostic code for PPCM, suggesting an increse in incidence of PPCM over the last twenty-three years. More research is needed to investigate reasons for that.

Funding Acknowledgement
Type of funding sources: None.
A comprehensive study of the incremental prognostic value of novel biomarkers in PARADIGM-HF (Bio-PREDICT-HF)
Authors: McDowell K , Simpson J , Jhund P S , Abraham W T , Claggett B , Cunningham J , Desai A S , Kober L , Prescott M , Rouleau J L , Swedberg K , Zile M R , Solomon S D , Packer M , McMurray J J V 
Published: October 2022

Abstract

Background
Although multiple novel biomarkers have individually been shown to predict outcomes in patients with HFrEF, the value of these over and above conventional clinical and laboratory variables, plus natriuretic peptides, is uncertain.

Purpose
To test the incremental predictive value of 11 novel biomarkers added to a recent prognostic model 1 (PREDICT-HF) derived in PARADIGM-HF and validated in ATMOSPHERE and the Swedish heart failure registry. The PREDICT-HF model includes clinical variables, standard laboratory variables, and BNP or NT-proBNP.

Methods
1559 participants enrolled in PARADIGM-HF had all 11 biomarkers of interest measured. These reflected different pathophysiological pathways: (i) myocyte injury (high sensitivity cardiac troponin T), (ii) cardiac remodelling and inflammation (growth stimulation expressed gene 2, growth differentiation factor-15 and galectin-3), (iii) extracellular matrix remodelling (matrix metalloproteinase-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1), (iv) neurohormonal pathways (aldosterone) and (v) renal dysfunction and injury (cystatin C, kidney injury molecule-1 and urinary albumin to creatinine ratio). The incremental prognostic value of these biomarkers was evaluated using Harrell's C statistic.

Results
The mean age of participants studied was 67.3 (SD 9.9) years, 1254 (80%) were men and 1103 (71%) were in NYHA class II. During a median follow-up of 31 months, 197 patients died and 300 experienced the primary composite outcome (cardiovascular death or heart failure hospitalization).
When each candidate biomarker (log unit) was added individually to the PREDICT-HF base model, GDF-15, ST2, TIMP1, cystatin C, hsTnT and UACR were independent predictors of all-cause mortality (Table 1). GDF-15, TIMP1, hs-TnT and cystatin C consistently increased the risk of both all-cause mortality and the primary outcome. Individuals who had all 4 biomarkers elevated (compared to none elevated) had the highest risk: HR for all-cause mortality 3.65 (2.01–6.64), p&lt;0.0001. Adding these 4 biomarkers to the baseline PREDICT HF model improved the C statistic for all-cause mortality from 0.726 to 0.745.

Conclusion
Several novel biomarkers provide meaningful additional prognostic information in patients with HFrEF. A multimarker approach incorporating biomarkers reflecting different pathophysiological pathways added most information. This approach may be useful in refining risk and targeting treatment.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The PARADIGM-HF trial was funded by Novartis.J.J.V.M is supported by a British Heart Foundation Centre of Excellence Grant
Fibroblast growth factor-23 is an independent predictor of hospitalization for heart failure and major cardiovascular adverse events in patients undergoing cardiac surgery
Authors: Hofer F , Hammer A , Kazem N , Koller L , Steinacher E , Steinlechner B , Laufer G , Niessner A , Sulzgruber P 
Published: October 2022

Abstract

Background
Fibroblast growth factor 23 (FGF-23) plays a crucial role in regulating phosphate and vitamin D metabolism and was proved to be associated with an increased risk for fatal events in individuals suffering from cardiovascular diseases. Since data on the prognostic potential of FGF-23 in individuals undergoing cardiac valve and/or coronary artery bypass graft (CABG) surgery are scarce, the specific objective of this study was to investigate the impact of FGF-23 on postoperative complications, particularly postoperative atrial fibrillation (POAF), hospitalization for heart failure (HHF) and cardiovascular (CV) death in an unselected patient population after cardiac surgery.

Methods
Within the present investigation, patients undergoing elective cardiac valve and/or CABG surgery were prospectively enrolled at the Department of Cardiac Surgery of a medical university. Blood samples were taken prior to surgery and FGF-23 concentrations were subsequently assessed. Patients were followed prospectively until the primary study endpoint (CV death) was reached.

Results
In total, 462 patients were included in the present analysis and followed over a median of 3.9 years. During follow-up 67 (14.5%) patients died. The patients' median age was 70 years (interquartile range [IQR] 60 to 75) and 133 (28.8%) were female. The median FGF-23 level in the entire study population was 1.9 pmol/L (IQR 1.2 to 3.5). Notably, individuals with POAF showed significantly higher FGF-23 levels than patients without (p&lt;0.001). After stratification into tertiles (T) of FGF-23 patients in the highest FGF-23 tertile showed greater rates of HHF, all-cause and CV death. Furthermore, FGF-23 was consistently associated with POAF development showing an adjusted OR for a 1-unit increase in standardized log-transformed biomarker of 1.28 (95% CI: 1.01 to 1.63), along with an adjusted OR of 2.04 (95% CI 1.33 to 3.13, p=0.001) for the pre-defined high risk cut-off value. A steady risk increase for HHF and CV death among ascending FGF-23 tertiles has been noted. Moreover FGF-23 showed strong discriminatory performance (area under the curve [AUC] 0.69, 95% CI 0.61–0.77). Reclassification analysis indicated that the addition of FGF-23 to NT-proBNP provides a significant improvement in risk discrimination (NRI at the event rate: 0.58, 95% CI 0.34–0.81, p-value &lt;0.001; IDI: 0.03, 95% CI 0.01–0.05, p-value= 0.001).

Conclusion
FGF-23 proved to be a strong and independent predictor for POAF, HHF and CV death in individuals undergoing cardiac surgery. Considering an individualized risk assessment, routine preoperative FGF-23 evaluation may improve detection of patients at risk, who require in-depth clinical attention throughout the peri- and postoperative phase after cardiac surgery.

Funding Acknowledgement
Type of funding sources: None.