bluuebunny/crossref_metadata_2025_split huggingface dataset:
Gender-sensitive analysis of resynchronization therapy indications in 2021 European heart failure guidelines
Authors: Rilo I , Beramendi Calero J , Quintas Ovejero L , Rengel Jimenez A , Cea Primo D , Nunez Rodriguez A , Hernandez De Alba L , Calvo Chumillas S , Aldave Zabaleta P , Querejeta Iraola R 
Published: October 2022

Abstract

Introduction
Although there is evidence that women benefit very much more than men from resynchronization therapies even with narrower QRSs, the clinical practice guidelines for heart failure do not contemplate a different attitude taking into account gender.

Objective
The aim of this study is to analyze the clinical trials and registries on which the recommendations of the guidelines are based.

Methods
We selected in the bibliography of the 2021 European heart failure guidelines the registries and clinical essays and analyzed them attending to gender perspective according to the following questions:
Is gender treated as a primary variable? Is gender treated as a secondary variable?
Is there a differentiated analysis by sex? Are side effects described differently by sex?
What is the proportion of women in the study?

Results
We analyzed 16 articles. The proportion of women is between 15 and 25%. Only 6 in 16 articles reported a differentiated analysis by sex and there was only one article that differentiated side effects according to sex.

Conclusions
Gender analysis should be mandatory in all the clinical essays carried out in the future. Guidelines should consider different recommendations according to gender. Being excluded or infrarrepresented in studies could conditionate a discrimination to women not only now but also in the future when the algorithms of artificial intelligence condition the decisions we make in the different pathologies

Funding Acknowledgement
Type of funding sources: None.
The impact of dominant ventricle morphology and accessory ventricle size on clinical outcomes after Fontan procedure
Authors: Padalino M , Azzolina D , Puricelli F , Reffo E , Cabrelle G , Cavaliere A C , Guariento A , Castaldi B , Biffanti R , Vida V , Disalvo G 
Published: October 2022

Abstract

Objectives
the physio-pathological role of the morphological ventricular dominance (left, FSLV; right, FSRV), and the hemodynamic contribute of an accessory ventricular chamber (AVC), in patients with functional single ventricle (FSV) after Fontan operation are still uncertain due to conflicting data. We analyzed a cohort of Fontan patients to assess and correlate such anatomical features to late clinical outcomes.

Methods
We enrolled all patients after a Fontan procedure who underwent a cardiac magnetic resonance (CMR) and a cardiopulmonary exercise test (CPET) in the previous 3 years. Clinical, CMR and CPET data from the last follow-up visit were retrieved to analyze whether the size of any AVC and the morphological ventricular dominance (FSLV vs FSRV) were correlated with clinical outcomes (NYHA, need for reinterventions or cardiac transplantation, mortality, arrhythmias, liver disease and protein-losing enteropathy) and functional parameters (including FSV ejection fraction and presence of late gadolinium enhancement, LGE, on CMR and peak metabolic equivalents, pMETs, and peak oxygen consumption, pVO2, at CPET). All statistical tests were two tailed and significance was set at 0.05.

Results
we enrolled 50 patients: 29 had FSLV (58%), FSRV in 21 (42%). Median age at evaluation was 19.5 years [IQR 15–26]; median follow-up was 16 years [4–42]. NYHA class III or IV was present in 6%, while 4 (8%) underwent a re-do Fontan, 2 (4%) entered transplantation waiting list and one of these received a transplant. 2 patients (4%) died at follow-up. Statistical analysis showed that the accessory chamber was larger (&gt;20 cc/m2) in FSLV than in FSRV (p=0.01). In the post-operative period, FSRV was associated with higher incidence of low-cardiac output syndrome (p=0.043). In the long-term, there was no statistically significant difference in major clinical outcomes or NYHA class between the two groups. FSLV was associated with a better cardiac function (median FSV ejection fraction 56% vs 52%; p=0.041), less extent of LGE [p = 0.022], better functional capacity expressed by METs (14.1 vs 12.3; p=0.01) and pVO2 (1.625 ml/min vs 1.233 ml/min; p=0.033). An AVC was detected in all: its size was &lt;5 ml/m2 in 31%, 5–20 ml/m2 in 47%, and &gt;20 ml/m2 in 22%. A larger AVC was associated with higher need for postoperative ECMO support (p=0.007), while size of AVC was not associated to any statistically difference in clinical outcomes, cardiac function and functional capacity.

Conclusions
In Fontan circulation, a FSLV is correlated to better clinical and functional outcomes when compared to FSRV. On the other side, an AVC appears to be not significantly related to any clinical disadvantage. However, the immediate postoperative course may be influenced negatively by the presence of a larger AVC.

Funding Acknowledgement
Type of funding sources: None.
Advanced microstructural substrate detection in pre-hypertrophic HCM and its relationship to arrhythmogenesis; a hybrid CMR-ECG-Imaging study
Authors: Joy G , Webber M , Kelly C I , Pierce I , Teh I , Schneider J , Nguyen C , Kellman P , Orini M , Lambiase P , Rudy Y , Captur G , Dall'armellina E , Moon J C , Lopes L R 
Published: October 2022

Abstract

Background
Hypertrophic cardiomyopathy is defined in three domains; clinically by unexplained hypertrophy, genetically by sarcomeric gene mutations and histologically by disarray, small vessel disease and fibrosis. Both ischaemia and myocyte disarray have been implicated in arrhythmogenesis and sudden cardiac death but whether disarray occurs before hypertrophy and its relationship to ischaemia is unknown.
Diffusion-tensor CMR, perfusion mapping & ECG Imaging (ECGI) can measure disarray, ischaemia and electrical aberrance respectively in vivo. We aimed to investigate these in genotype positive (G+) subjects without hypertrophy (LVH−) to identify further subclinical manifestations of gene expression and whether these relate to ventricular arrhythmia formation.

Methods
Diffusion-tensor CMR (3-Tesla) using a motion-compensated spin-echo sequence was acquired in 3 short-axis slices. Quantitative adenosine stress perfusion mapping was performed using standard clinical protocols. A novel ECGI vest, containing 256 unipolar electrodes acquired a 5-minute recording of body-surface potentials to quantify conduction and repolarisation dynamics intervals.

Results
ECGI/CMR was performed on 68 mutation carriers from 64 families and 24 age sex and ethnicity matched healthy controls. Of the mutation carriers, median age was 33 (24–41 years), 57% (39) were female, and 79% (54) were white. Mutations were 39 (57%) MYBPC3, 19 (28%) MYH7, 1 (1%) MYL2 and 9 (12%) were thin filament/non-sarcomeric mutations. There was no significant difference in ejection fraction or LV mass, however G+LVH− had a higher maximum wall thickness (9 (9–10) vs 8 (7–9) mm p=0.003).
Compared to healthy volunteers, G+LVH− individuals had more perfusion defects (18/64 (30%) vs 0, p=0.004), lower Fractional Anisotropy (FA) (suggestive of more disarray) (0.32±0.02 vs 0.34±0.02, p&lt;0.0001) and more prolonged Activation–Recovery Intervals (ARI, a surrogate for action potential duration (259±40 vs 240±31 ms, p=0.03).
In G+LVH−, patients with perfusion defects had more prolonged ARI (263 (248 vs 292) vs 246 (225–283) ms, p=0.03) and lower FA suggestive of more disarray (0.32±0.2 vs 0.31±0.1, p=0.04).

Conclusion
Ischaemia, myocyte disarray and electrical abnormalities occur even in the absence of hypertrophy in HCM. These abnormalities associate to form a complex a clinical phenotype.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): British Heart FoundationBarts Charity
Exercise capacity and imaging for the prediction of cardiovascular, cancer and noncardiovascular noncancer death in senior people
Authors: Peteiro Vazquez J C , Bouzas-Mosquera A , Barbeito-Caamano C , Vazquez-Rodriguez J M 
Published: October 2022

Abstract

Exercise echocardiography (ExE) can predict overall and cardiovascular mortality. We aimed to assess the value of imaging and functional capacity by ExE for the prediction of cardiovascular (CV), cancer (CA) and non-cardiovascular non-cancer (NCV-NCA) death in senior people.

Methods
Retrospective analysis of prospectively collected data on 1,826 patients aged ≥75 years (79±3 years, 44% women) with a first treadmill ExE performed in our center for known/suspected coronary artery disease. Exclusion criteria were significant valve disease, cardiomyopathy, and congenital heart disease. Ischemia was defined as new wall motion abnormalities (WMAs) with exercise; abnormal ExE as ischemia or resting WMAs. A good functional capacity was defined as a maximal workload of 10 metabolic equivalents (METs). The end point was death (CV, CA or NCV-NCA).

Results
During a median follow-up of 2.7 years (interquartil range 0.3–6.2 years) there were 642 deaths: 306 CV, 143 CA, and 174 NCV-NCA deaths. Multivariate analysis included clinical characteristics, resting echocardiography, exercise testing and peak exercise echocardiography. Different clinical characteristics including age, sex, and coronary risk factors predicted CV death, along with maximal achieved workload in Metabolic Equivalents (METs: Hazard Ratio [HR]=0.98, 95% Confidence Interval [CI]=0.96–0.99, p&lt;0.001) and ExE variables. CA death was independently predicted by gender as well as for achieved METs (HR=0.91, 95% CI =0.85–0.97, p=0.003). Similarly NCV-NCA death was predicted by clinical characteristics (age, diabetes mellitus, dyspnea, peak double product) and also by the achieved METs (HR=0.93, 95% CI: 0.89–0.97, p&lt;0.001). Nor ischemia nor abnormal ExE were predictors of CA or NCV-NCA death. Annualized CV, CA and NCV-NCA deaths according to ExE results and functional capacity are depicted in Figure 1.
In conclusion, the “exercise part” of an ExE study predicts not only CV death, but death due to CA or to NCV-NCA in elder patients. Senior but fitness patients based on the achievement of 10 METs during exercise testing, have less chance of death of any cause.

Funding Acknowledgement
Type of funding sources: None.
Outcomes of sodium-glucose co-transporter type 2 inhibitors use in elderly patients with heart failure with reduced ejection fraction
Authors: Balaguer German J , Cortes Garcia M , Rodriguez Lopez C , Romero Otero J M , Esteban Chapel J A , Nieto Roca L , Martinez Milla J , Taibo Urquia M , Pello Lazaro A M , Tunon Fernandez J 
Published: October 2022

Abstract

Background
Heart failure is a highly prevalent condition, especially in patients over 75 years. In recent years, new therapeutic lines have emerged for the management of heart failure with reduced ejection fraction (HFrEF), most notably sodium-glucose co-transporter type 2 inhibitors (iSGLT2). However, there are currently low evidence of the benefit in this subgroup.

Methods
A retrospective study was conducted from January 2016 to December 2020 in our hospital. All patients aged ≥75 years, diagnosed with HFrEF (defined by left ventricular ejection fraction &lt;40%), and current guidelines recommendations for iSGLT2 were included. Clinical, electrocardiographic and echocardiographic data were collected.

Results
A total of 616 patients were included, with a mean age at the inclusion of 83.3 years (standard deviation, SD, ± 5); 65.6% of the patients included were male. 81.2% were hypertensive, 35.4% were diabetic. 46.2% had chronic kidney disease (defined as glomerular filtrate &lt;60mL/min/1.73 m2). Chronic lung disease was present in 14.8% of the patients, 16.2% had a history of cerebrovascular events and 12.7% suffered from peripheral vascular disease. The most frequent cause of HFrEF was ischemic, with 53.9%. A total of 86.8% presented a NYHA I-II; in 60.3% of the subjects, the rhythm at inclusion was sinus rhythm. The percentage of patients with BB was 76.9%, with ACEI / ARB 69.8%, 14.3% with ARNI and with anti-aldosterone agents 40.4%. The percentage of patients with SGLT2i was only 4.2%. The median follow-up was 34.5 months, during which 50.4% of the population died and 62.5% had a cardiovascular event (death or hospitalization for heart failure). A survival analysis using Cox regression showed that SGLT2i in this subgroup of patients was a protective factor against mortality (HR 0.124; 95% CI 0.031–0.497) and cardiovascular events (HR 0.428; 95% CI 0.221–0.830)

Conclusion
Despite current recommendations in the guidelines, there is marked underuse in elderly patients of SGLT2i. This could be related to greater intolerance or contraindication, but also to a lesser application of the clinical evidence in this population group. However, the use of SGLT2i has been shown as a significant factor associated with improved survival and comorbidity rate in our study population.

Funding Acknowledgement
Type of funding sources: None.
Prognostic role of cardiac magnetic resonance in left ventricular non compaction
Authors: Azpiroz Franch M J , Casas Masnou G , Romero A , Gonzalez Del Hoyo M I , Larranaga Moreira J M , Escalona Silva R , Guala A , Limeres Freire J , Bayes De Luna A , Zorio Grima E , Villacorta Arguelles E , Garcia Pavia P , Barriales Villa R , Ferreira Gonzalez I , Rodriguez Palomares J F 
Published: October 2022

Abstract

Introduction
Left ventricular non compaction (LVNC) is a heterogeneous entity with uncertain prognosis. Cardiac magnetic resonance (CMR) is widely used in the diagnosis of LVNC. However, its role in risk stratification has not been well established.

Purpose
Therefore, the aim of our study was to identify prognostic CMR variables in LVNC.

Methods
We conducted a retrospective longitudinal multicentre cohort study of consecutive patients fulfilling CMR LVNC criteria. The endpoints were heart failure (HF), ventricular arrhythmias (VA), systemic embolisms (SE) and all-cause mortality. Biventricular volumes, ejection fraction (LVEF and RVEF) as well as late gadolinium enhancement (LGE) were analysed.

Results
A total of 310 patients were included: age was 44.4±19 and 43% female. LVEF was 47% ± 15%, RVEF was 48±12 and 28 patients (9%) presented LGE. After a median follow-up of 3.8 2.5 years, 40 patients (13%) presented HF, 31 (10%) had VA, SE occurred in 6 (2%) and 3 patients (1%) died. Baseline characteristics of patients with and without HF and VA are described in Table 1.
In univariate analysis, LVEF, LV volumes, LGE, and RVEF were associated with both HF and VA risk. In multivariate analysis, LVEF was the only variable independently associated with HF (HR 0.932, CI 95% 0.88–0.97, p 0.003). Patients with an LVEF &gt;35% were at very low risk of HF (Figure 1A). With regards to VA, LGE was the only independent predictor (HR 2.64, IC 95% 1.059–6.61, p 0.003) (Figure 1B). In LGE negative patients, the arrhythmic risk was higher among those with an LVEF &lt;35% (HR 2.81, 95% CI 1.02–8.12, p 0.047).

Conclusions
In a large multicentre retrospective LVNC study, left ventricular ejection fraction and late gadolinium enhancement were the main predictors of cardiovascular events. Patients with an LVEF &lt;35% and with LGE were at markedly increased risk. Therefore, we suggest that these variables should be combined to enhance risk stratification in LVNC.

Funding Acknowledgement
Type of funding sources: None.
Prevalence and outcomes of atrial fibrillation in older people living in care homes in Wales: a routine data linkage study 2003–2018
Authors: Ritchie L A , Harrison S L , Penson P E , Akbari A , Torabi F , Hollinghurst J , Harris D , Oke O B , Akpan A , Halcox J P , Rodgers S E , Lip G Y H , Lane D A 
Published: October 2022

Abstract

Background
Older care home residents are a high-risk group of people with atrial fibrillation (AF) who are under-represented in clinical trials. Improved understanding of AF epidemiology and management in this population is paramount for health and social care organisations to strategically plan services.

Purpose
To determine the trends in AF prevalence and compare adverse health outcomes in older care home residents aged ≥65 years with AF compared to those without AF.

Methods
Retrospective cohort study of people entering a care home between 2003–2018 using nationwide, population-scale anonymised health and administrative data, provisioned from the Secure Anonymised Information Linkage (1 January 2000–31st December 2018). Direct standardisation was used to calculate AF prevalence by year of care entry (2010–2018). Cox regression analyses were used to estimate the risk of adverse health outcomes.

Results
Between 2003 and 2018, 86,602 people aged ≥65 years became new residents in care homes in Wales. Residents with AF (n=14,493) had a significantly higher risk (adjusted hazard ratio [aHR], 95% confidence interval [CI]) of cardiovascular (aHR 1.27 [1.17 to 1.37], p&lt;0.001) and all-cause mortality (aHR 1.14 [1.11 to 1.17], p&lt;0.001), Figure 1. The risk (sub-distribution hazard ratio [sHR], 95% CI) of ischaemic stroke (adjusted sHR 1.55 [1.36 to 1.76], p&lt;0.001) and cardiovascular hospitalisation (adjusted sHR 1.28 [1.22 to 1.34], p&lt;0.001) was also higher in residents with AF, even when mortality was considered a competing event, Figure 1. There was no significant change in age- and sex-standardised prevalence of AF between 2010 and 2018, 16.79% (95% CI 15.85 to 17.94) and 17.02% (95% CI 16.05 to 17.98), respectively (absolute change 2010–2018: 0.06% [95% CI: −1.38 to 1.50], p=0.93), Figure 2.

Conclusions
This study demonstrates unique data on the epidemiology of AF and associated outcomes in older care home residents. Whilst the prevalence of AF remained stable between 2010–2018, residents with AF had significantly higher risk of adverse health events. Treatment of AF in accordance with guidelines is critical in this population to optimise management and reduce adverse health outcomes.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 vaccine-induced myocarditis vs. immune checkpoint inhibitor-induced myocarditis – same but different?
Authors: Zornitzki L , Havakuk O , Rozenbaum Z , Viskin D , Arbel A , Banai S , Topilsky Y , Laufer-Perl M 
Published: October 2022

Abstract

Background
While immune checkpoint inhibitors (ICI) -induced myocarditis and coronavirus disease 2019 (COVID-19) vaccine-induced myocarditis are considered to be rare; they are both significant side effects, suggested being caused by activation of the immune system against the myocardium. We aimed to assess whether both phenomena share similar presenting characteristics.

Methods
We included patients diagnosed with either ICI or COVID-19 vaccine-induced myocarditis at our medical center. We performed a retrospective assessment of clinical presentation, blood tests, and advanced echocardiography, including speckle strain.

Results
We included 18 patients diagnosed with ICI (ICI group) or COVID-19 vaccine (COVID-19 group)-induced myocarditis, and 20 patients with viral myocarditis (Viral group) as a control group. The median age was significantly older in the ICI group (74 years) compared to the COVID-19 and Viral groups (20 and 24 years), p&lt;0.001. The clinical presentation in the COVID-19 group was more similar to the Viral group, presenting mainly with chest pain and fever, while the ICI group presented mainly with dyspnea. ST-elevation was frequent in the COVID-19 and Viral groups and absent in the ICI group, p=0.004. Median peak high sensitivity troponin I values were markedly lower in the ICI group compared to the COVID-19 and Viral groups (619 ng/L vs. 15527 ng/L vs. 7388 ng/L, p=0.004). While the median left ventricular ejection fraction was 60% among all groups, patients in the ICI group presented with mean lower LV global longitudinal strain (−13%) and left atrial conduit strain (17%), compared to the COVID-19 (−17% and 30%) and Viral groups (−18% and 37%), p=0.016 and p=0.001.

Conclusions
While the suspected mechanism is an activation of the immune system in both ICI and the COVID-19 vaccine-induced myocarditis, we found that the clinical presentation, cardiac biomarkers, and advanced echocardiography of the COVID-19 vaccine, are more similar to viral myocarditis than to ICI-induced myocarditis.

Funding Acknowledgement
Type of funding sources: None.
Emergency department cardiovascular disease encounters and associated mortality in patients with cancer: a study of 20.6 million records from the USA
Authors: Kobo O , Moledina S M , Raisi-Estabragh Z , Chieffo A , Alraies M C , Biondi-Zoccai G , Mohamed M , Roguin A , Mamas M A 
Published: October 2022

Abstract

Background
There is limited data on Emergency department (ED) cardiovascular disease (CVD) presentations and outcomes amongst cancer patients.

Objectives
The present study aimed to describe the clinical characteristics, prevalence, and clinical outcomes of the most common cardiovascular ED admissions in patients with cancer.

Methods
All ED encounters with a primary CVD diagnosis from the US Nationwide-Emergency Department Sample between January 2016 to December 2018 were stratified by cancer type as well as metastatic status. Multivariable logistic regression was performed to determine the adjusted odds ratios of in-hospital mortality in different groups.

Results
From a total of 20,737,247 ED encounters with a primary CVD diagnosis, cancer was present in 3.4%. In patients with cancer the most common CVDs were DVT/PE (20%), hypertensive heart or kidney disease (14.7%), and AF/flutter (11.2%). The distribution of CVDs varied by cancer type, with AF/flutter most common in patients with lung cancer, AMI most common in patients with prostate cancer, heart failure most common in those with haematological malignancies, and patients with colorectal cancer having the greatest frequency of DVT/PE. Cancer status was independently associated with significantly higher risk of mortality in almost all CVD categories, consistent across all the cancer types, amongst which lung cancer patients had the highest risk of mortality across all CVD categories, except intracranial haemorrhage and hypertensive crisis.

Conclusions
Cardiovascular presentations to the ED varied by cancer subtype. Across all cancer subtypes, patients presenting with cardiovascular presentations carried a significantly increased risk of mortality compared to patients with no cancer.

Funding Acknowledgement
Type of funding sources: None.