bluuebunny/crossref_metadata_2025_split huggingface dataset:
Left and right ventricular function alterations in obstructive sleep apnea patients assessed by 2D speckle tracking echocardiography
Authors: Tamulenaite E , Kondrataviciene L , Miliauskas S , Ereminiene E 
Published: October 2022

Abstract

Introduction
Obstructive sleep apnea (OSA) is related to increased left ventricular (LV) transmural pressure, blood pressure instability and increased pulmonary artery pressure (PAP) leading to left and right ventricular (RV) dysfunction and heart failure. 2D speckle tracking echocardiography (STE) is useful method for subclinical biventricular dysfunction diagnosis, thus might help to earlier treatment for OSA patients.

Purpose
The aim of the study was to evaluate changes of biventricular function and mechanics in patients with OSA.

Methods
We obtained 2D STE from 47 obese patients. 13 patients either did not have OSA, or it was mild (apnea/hypopnea index (AHI) 5–14/hour). OSA group (N=34) consisted of subjects with moderate or severe OSA (AHI ≥15/hour). New indexing for LV myocardial mass and LA volume by height was applied according new guidelines for obese patients. Statistical analyses were performed using the SPSS 27.0 software. The value of p&lt;0.05 was considered as statistically significant.

Results
BMI did not differ between groups (p=0.108). Control group patients were younger, had higher female ratio, meanwhile arterial hypertension was more prevalent in OSA group (26 (76.5%) vs. 5 (38.5%), p=0.014). New indexing by height for left ventricular myocardial mass revealed higher LV MMi in OSA patients (p=0.007), and higher prevalence of LV diastolic dysfunction (p=0.023) was found in this group of patients. Moreover, LA reservoir function was significantly lower in OSA group compared to controls p&lt;0.001. LV ejection fraction and conventional RV function parameters (s', fractional area change (FAC)) did not differ between groups, however LV and RV global longitudinal strain was reduced in OSA patients (p=0.035 and p=0.026, respectively). OSA patients had significantly higher RA diameter, and mean PAP (p=0.043 and p=0.037, respectively) (Table 1).

Conclusions
Moderate or severe obstructive sleep apnea is related to reduced biventricular longitudinal strain, more prevalent LV diastolic dysfunction and lower LA reservoir function. New indexing for LV myocardial mass by height helps to identify myocardial structural changes in obese patients with OSA.

Funding Acknowledgement
Type of funding sources: None.
Predicting the long-termoutcome of patients admitted with acute heart failure to the emergency department using renal markers
Authors: De Almeida J P L , Martinho S , Campos G , Alves P , Rosa J , Ferreira M , Goncalves L 
Published: October 2022

Abstract

Introduction
Renal dysfunction is one of the most important comorbidities in patients with chronic heart failure (HF) and frequently accentuated in the setting of acute HF (AHF). Serum creatinine and blood urea nitrogen (BUN) have been classically used as markers of renal dysfunction, despite having several limitations. High (BUN)/creatinine ratio has been associated with higher mortality in patients with HF. We aimed to predict the long-term outcome of patients admitted with acute heart failure to the emergency department using renal markers.

Methods
900 patients admitted to our emergency department diagnosed with AHF were retrospectively analysed. Patients were divided into 4 groups according to BUN and SCr on admission:
– BUN ≤33 mg/dL and SCr ≤1.56 mg/dL (group LowBUN/LowCr), n=544;
– BUN ≤33 mg/dL and SCr &gt;1.56 mg/dl (group LowBUN/HighCr), n=25;
– BUN &gt;33 mg/dL and SCr ≤1.56 mg/dL (group HighBUN/LowCr), n=131;
– BUN &gt;33 mg/dL and SCr &gt;1.56 mg/dL (group HighBUN/HighCr), n=200;
The primary end-point of this study was the occurrence of all-cause mortality during follow-up.

Results
The median (IQR) BUN level on admission was 28.0 (20) mg/dL, median (IQR) SCr level on admission was 1.15 (0.73) mg/d, mean age was 81±7 years, 50.8% (n=457) were women and median follow up was 7 months. A total of 41.2% patients were diabetic, 21.7% had at least mild COPD, CAD was present in 28.9% of cases, 44.0% had valvular heart disease and 68.4% patients had atrial fibrillation.
Creatinine, BUN and Cr/BUN ratio predicted survival at 6 months (p&lt;0.05).
Survival was the lowest in the group HighBUN/HighCr and the highest in the group LowBUN/LowCr. As expected, BUN/Cr ratio was the highest in group HighBUN/LowCr and the lowest in group LowBUN/HighCr.

Conclusions
Despite not having the highest BUN/Cr ratio, patients with BUN &gt;33 mg/dL and SCr &gt;1.56 mg/dL showed the worst prognosis.

Funding Acknowledgement
Type of funding sources: None.
Living with heart failure: quality of life, particularly sexual life, is impaired by emotional burden as reported by patients
Authors: Wehrmann L , Hausmann L , Pohlink C 
Published: October 2022

Abstract

Background
Symptoms of heart failure (HF) include shortness of breath and limited exercise capacity as a result of fluid retention and circulatory disorders. Life expectancy of HF patients has improved, mainly driven by current treatment modalities. The burden of HF in terms of quality of life (QoL) and emotional well-being is frequently neglected and is less well described than typical HF symptoms.

Purpose
The aim of this study is to better understand the impact of HF on patients' QoL and emotional well-being from the patients' perspective.

Methods
Data on disease perception and physical as well as emotional burden was collected using an online survey from Nov to Dec 21 from patients with HF diagnosis (Nfemale=830; Nmale=927).

Results
Overall, the majority of HF patients considered being capable of fulfilling everyday routines as highly important. In detail, 87% of HF patients rated taking care of themselves, 82% running the household independently, 83% mobility outside the house and 74% social life with highest importance*. Impairments in the same QoL determining aspects from above showed a bimodal distribution of HF patients meaning that they were either highly affected or not affected at all.
Male and female HF patients rated QoL aspects in terms of importance and impairment equally, except sexual life importance and sexual impairments, which were ranked higher by men (56% vs. 42%*, 39% vs. 32%§, respectively).
Being asked about their biggest concern regarding HF via an open-ended question, death was the most commonly reported term. However, 20% indicated social and emotional worries as their first concern. Indeed, HF patients were frequently emotionally affected and almost every second HF patient stated considerable restrictions of their daily obligations and every third of their social life due to emotional problems. Patient-reported emotions were being worried (53%#), listless/without energy (47%#), fatigue (45%#) and/or afraid (42%#).
Interestingly, the fraction of HF patients being unsatisfied with their sexual life was larger when patients indicated feeling emotionally affected (worried, listless, fatigue, afraid). On the other hand, HF patients indicating no negative emotions were more satisfied with their sexual life highlighting the importance of sexual health contributing to QoL.

Conclusion(s)
The emotional burden experienced by HF patients is as high as their physical impairments culminating in considerable restrictions of their daily routines due to emotional problems. Additionally, emotional well-being is strongly linked with sexual satisfaction.
*On a scale from 1 = “not important” to 10 = “very important” rated ≥7.
§On a scale from 1 = “not affected” to 10 = “no activity possible” rated ≥7.
#On a scale of 1 = “never” to 10 = “very often” rated ≥7.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH
The burden and pattern of comorbidities and its relation to mortality in frail vs non-frail patients with chronic heart failure
Authors: Sze S , Pellicori P , Zhang J , Weston J , Squire I B , Clark A 
Published: October 2022

Abstract

Background
Frailty is common in patients with chronic heart failure (CHF). Frail patients are at high risk of poor clinical outcomes which might be attributable to the presence of multiple comorbidities. The impact of comorbidities on mortality in frail patients with CHF is not well described.

Aim
To compare the burden and patterns of comorbidities in frail vs non-frail patients with CHF and their impact on mortality.

Methods
We studied consecutive patients attending a routine follow-up visit to a HF clinic. Frailty was assessed using the Clinical Frailty Scale (CFS); those with CFS&gt;4 were classified as frail. Patients were classified into 6 comorbidity groups including: metabolic (obesity, diabetes); respiratory; renal; cancer; neuropsychiatric (depression, dementia); and degenerative (falls, arthritis, fragility fractures). We investigated the relation between frailty, comorbidity groups and all-cause mortality in patients with CHF.

Results
Amongst 467 patients with CHF [67% male, median (IQR) age 76 (69–82) years, NTproBNP 1156 (469–2463) ng/L], 291 patients had HF with reduced ejection fraction (HFrEF, LVEF &lt;40%), and 176 had HF with preserved ejection fraction (HFpEF, LVEF ≥40%). Frailty was more common in HFpEF vs HFrEF (51 vs 40%). 64% of patients had &gt;4 comorbidities (36% 5–6, 21% 7–9 and 7% &gt;9 comorbidities).
Frail patients were more likely to have multiple comorbidities than non-frail patients (85% vs 48% with &gt;4 comorbidities, p&lt;0.001). The number of comorbidities increased with worsening frailty severity (Figure 1). Those with HFrEF were more like to suffer from cancer, whereas those with HFpEF were more likely to have neuropsychiatric, metabolic and degenerative comorbidities.
During a median follow up of 554 days, 82 (18%) patients died. Increasing number of comorbidities was associated with increasing mortality. (Figure 2) Patients who were frail with &gt;4 comorbidities had a 6-fold increased risk of mortality compared to those who were neither frail nor had multiple comorbidities [HR (95% CI) 6.6 (3.2–13.9), p&lt;0.001]. In a model adjusted for age, sex, logNTproBNP and NYHA class, amongst comorbidity groups, the presence of renal and neuropsychiatric comorbidities were independent predictors of higher mortality.

Conclusion
Frail patients with CHF have a high comorbidity burden. The co-existence of frailty and multiple comorbidities predisposes to higher risk of mortality. Future studies should investigate whether treatment focusing on comorbidities improve outcomes.

Funding Acknowledgement
Type of funding sources: None.
Hyponatremia and in-hospital outcomes of patients admitted for heart failure: analysis of the national inpatient sample
Authors: Kang C , Asemota I , Reyes Pinzon V , Khamooshi P , Atluri R , Soon-Shiong R 
Published: October 2022

Abstract

Background
Hyponatremia serves as a well established predictor of mortality for advanced heart failure (1). The aim of this study is to reassess the association between hyponatremia and in-hospital outcomes in patients with acute decompensated heart failure (ADHF) by using a nationally representative sample.

Methods
We queried the National Inpatient Sample (NIS) database collected between 2016 and 2018 to identify patients with a primary diagnosis of HF and stratified the cohort on the basis of presence or absence of hyponatremia. The outcomes of interest included in-hospital mortality, common associated complications and usage of circulatory support.

Results
Among 727,629 hospital admissions for HF, 72,824 (10%) of them had an additional diagnosis of hyponatremia. The hyponatremia cohort appeared similar in age and had similar rates of Charlson comorbidity index greater than 4 (71 years vs 72 years and 33% vs 35%, respectively) compared to the non-hyponatremia cohort. The comorbidities more prevalent in patients with hyponatremia included: hypothyroidism (17% vs 21%, p&lt;0.001), liver disease (4% vs 11%, p&lt;0.001) and anemia (31% vs 42, p&lt;0.001). By contrast, dyslipidemia, chronic obstructive pulmonary disease, chronic kidney disease, hypertension, diabetes mellitus, obesity, smoking status and supplemental oxygen use were comparable in both groups. ADHF patients with hyponatremia did not have higher odds of in-hospital mortality (aOR: 1.08, 95% CI: 0.98–1.19, p=0.138) when adjusted for comorbidities. Nevertheless, patients with hyponatremia had an adjusted increase in mean hospital charges of 14,731 US$ (95% CI: 11065–18397, p&lt;0.001), length of stay by 2.6 days (95% CI: 2.5–2.8, p&lt;0.001), usage of intra-aortic balloon pump (aOR: 1.97, 95% CI: 1.50–2.59, p&lt;0.001) and left ventricular assist device (aOR: 2.21, 95% CI: 1.639–2.98, p&lt;0.001), and higher incidence of acute renal failure (aOR: 1.13, 95% CI: 1.08–1.189, p&lt;0.001) and cardiogenic shock (aOR: 1.58, 95% CI: 1.42–1.76, p&lt;0.001) in comparison to patients without hyponatremia.

Conclusion
Multiple clinical variables excluded in the NIS dataset could have impacted the primary outcome. Clinicians who observe hyponatremia in ADHF patients should stay wary of potential side effects and maintain a low threshold to escalate care.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 vaccination decrease the risk of Intensive Care Unit hospitalisation in heart failure patients even in the time of Omicron variant: population based study
Authors: Parenica J , Jarkovsky J , Benesova K , Hlasensky J , Miklikova M , Kala P , Ondrus T , Lokaj P , Dusek L 
Published: October 2022

Abstract

Background
Heart failure (HF) patients, especially those in higher age, are at high risk of severe course of COVID-19.

Purpose
The aim of this work was to compare the risk of the necessity of intensive care being provided in the Intensive care units in HF patients with and without COVID-19 vaccination in the time of Omicron variant.

Methods
The analysis was done on data from the National Health Information System, which was supplemented with data from the Information System of Infectious Diseases.

Results
At the beginning of 2022, we estimate a total of 128,848 HF patients. Of these, 52.5% were men, mean of age (±SD) was 71.8 (±11.6) years, mean of age of women was 78.2 (±10.7). In January 2022, 560,886 cases of COVID-19 were diagnosed in the Czech Republic (5,241.1 cases per 100,000 population), the mean of the age was 32.5 (±18.3) years. At this time, the Omicron variant prevailed in the Czech Republic. Total 1,667 COVID-19 cases were HF patients, 56.3% were men. Not vaccinated were 420 patients, vaccinated without booster were 556 patients and vaccinated with booster were 691 patients. The risk of hospitalisation within 14 days from COVID-19 diagnosis was 46.7% (95% CI 41.5%; 51.8%) in not vaccinated group, 37.0% (32.9%; 41.2%) in vaccinated group and 22.6% (19.8; 26.0%) in vaccinated with booster group. The risk of the necessity of intensive care being provided in the Intensive care units was 11.1% (7.7%; 14.5%) in not vaccinated group, 4.7% (2.8%; 6.6%) in vaccinated group and 3.7% (2.0%; 5.4%) in vaccinated with booster group (Figure 1).

Conclusion
COVID-19 vaccination decrease the risk of Intensive Care Unit hospitalisation in heart failure patients even in the time of Omicron variant.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): The Ministry of Health of the Czech Republic – conceptual development of research organisation (FNBr, 65269705; funding was given to University Hospital Brno)
Left ventricular ejection fraction is not a determinant of outcome in acute heart failure
Authors: Berrill M , Ashcroft E , Baltabaeva A 
Published: October 2022

Abstract

Aims
Attention to left ventricular performance in acute heart failure (AHF) has historically focussed on deteriorating systolic function in the left ventricle (LV) as assessed by impaired LV ejection fraction (LVEF).

Methods
418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bed-side echocardiography within 24 hours of recruitment. LV systolic function was assessed by LVEF &gt;50% (HFpEF), 41–49% (HFmrEF) and &lt;40% (HFrEF). Contractile function was assessed by LV MR dp/dt with ROC analysis identifying the cut-off of 570mmHg/s with the maximum Younden Index. Diastolic function was assessed by the ratio of mitral inflow E wave velocity to lateral e' velocity (E/e'), with a cut-off of 10.9 associated with the maximum Younden Index.

Results
The average age of patients was 78.7±11.7 years and 47.1% of patients were female. Mean BNP was 1331 pg/ml. 55.5% of patients had hypertension, 36.4% had coronary artery disease, 31.1% diabetes and 45.2% chronic kidney disease. Overall 2-year mortality was 38%. A 3-way comparison of 2-year mortality by LVEF (HFpEF vs. HFmrEF vs. HFmrEF) from ESC guideline criteria was not prognostic (38.6% vs. 30.9% vs. 43.9% [p=0.10). An LV MR dp/dt cut-off of 570mmHg was associated with worse outcome (HR 1.55 95% CI (1.05–2.29 [p=0.026]). Cut-offs for diastolic dysfunction identified from this AHF cohort (E/e' &gt;10.9) and from ESC guidelines (E/e' &gt;14) [p=0.09 & p=0.20]) could not identify those at risk of poor outcome.

Conclusion
In this study of acute heart failure LV ejection fraction is not associated with prognosis. LV systolic function assessed by the MR dp/dt, a measure of global contractile function, identified a cut-off of 570mmHg which could predict 2-year outcome. This suggests decline the ability of LV to generate contractile force predicts outcome in AHF. Diastolic function remains challenging to assess and a crude evaluation using E/e' could not identify those at risk of poor outcome in AHF.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
Pre-discharge B-lines at bedside predicts 30-day and multiple 90-day hospital re-admission in patients admitted for acute decompensated heart failure
Authors: Zisis G , Huynh Q , Whitmore K , Lay M , Yang Y , Carrington M , Marwick T 
Published: October 2022

Abstract

Background
Inadequate decongestion at index admission for Acute Decompensation of Heart Failure (ADHF) is a common cause of adverse outcomes. A bedside 9-zone Lung and IVC ultrasound assessment (LUICA) may help to guide decongestion and reduce hospital readmission or mortality.

Purpose
To identify predictors of multiple 90-day hospital representations or mortality based on a bedside handheld 9-zone LUICA volume assessment obtained by HF nurses.

Methods
Patients admitted for ADHF, enrolled in the RISK-HF registry and undergoing pre-discharge LUICA, were assessed for 90-day readmission and/or mortality. The primary outcome of this observational report was prediction of multiple hospital representations based on pre-discharge volume status. The LUICA was performed with a hand-held ultrasound (HHU) device (Lumify, Philips) by trained HF-nurses. Functional capacity was measured with Duke Activity Status Index (DASI). Paired t-tests were used to compare mean differences. Logistic and linear regression were used to study relationships of outcomes with clinical characteristics. Cox regression was used to analyse time to repeated readmission or death. Analysis conducted with SPSS statistics V27 and STATA SE16.

Results
Of 302 ADHF patients, 67 readmitted within 30-days (age 76±8.5; men, 60%; HFrEF; 44%) and 235 did not readmit within 30-days (age 72±14; 57% men; 52% HFrEF). Readmission occurred in older patients (p=0.05), with pre-discharge signs of residual congestion that was based on the number of b-lines (p&lt;0.01) (Table 1). Pre-discharge B-lines were predictive of DAOOH (β −0.41, −0.6, −0.22, p&lt;0.01) and of multiple 90-day hospital readmissions (β 0.03, 0.018, 0.05, p&lt;0.01), independently of 30-day event risk score, number of readmissions the preceding 12 months and age at index admission (Table 2). Number of B-lines at discharge was also associated with repeated readmission or death (HR=1.02 [1.01, 1.04]) in time-to-event analysis, independent of any other factors.

Conclusion
Pre-discharge residual congestion defined by the number B-lines increases the likelihood of multiple 90-day adverse outcomes.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The University of MelbourneBaker Heart & Diabetes Institute
Should we continue trusting bodyweight for HF volume telemonitoring?
Authors: Casquete D , Numan L , Codina P , Domingo M , Santiago-Vacas E , Cediel G , Zamora E , Crespo E , Santesmases J , Ruiz-Cueto M , Bares D , Altabella M , Barcelo E , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Telemonitoring of body weight, blood pressure and heart rate has extensively been used to facilitate early recognition of heart failure (HF) decompensations in order to prevent hospital admissions. Mixed results have been shown by different clinical trials regarding the effectiveness of telemonitoring in HF management. It is recognized that HF decompensation starts with an increase in intra cardiac filling pressure. The relationship between daily pulmonary artery pressure (PAP) values measurements and body weight is not completely established.

Purpose
To study the relationship between daily changes in body weight and invasive daily measurements such as diastolic PAP assessed by a pulmonary artery pressure sensor (CardioMEMS).

Methods
Eleven patients with left sided chronic HF implanted with a CardioMEMS device were included in the study (age 75±9 years, ejection fraction 52±10%). Daily measured body weight and pulmonary artery pressures were recorded during 6 months. The primary endpoint was to assess the correlation between the “PAP deviation” – defined as the difference between daily diastolic PAP and mean diastolic PAP over the study period – and the “weight deviation” – defined as the difference between daily body weight determinations and mean body weight.

Results
During the 6-months study period, 1766 body weight and diastolic PAP measurements were recorded (158±47 daily measurements per patient). We found a weak although significant correlation between changes in body weight and changes in diastolic PAP (Figure 1). When analyzing data individually, no patient presented a strong correlation between the two variables.

Conclusions
Our results suggest that repeated measurements of body weight have limited utility in detecting left sided heart failure decompensations. More complex and patient-specific thresholds for the biometric measurements are needed to improve early detection of decompensation in HF patients. For the development of early detection algorithms, we may learn from invasive methods, such as the CardioMEMS device.

Funding Acknowledgement
Type of funding sources: None.