bluuebunny/crossref_metadata_2025_split huggingface dataset:
Machine-learning algorithms for prediction of survival by stress echocardiography in chronic coronary syndromes
Authors: Gaibazzi N , Cortigiani L , Ciampi Q , Lorenzoni G , Rigo F , Gherardi S , Bovenzi F , Gregori D , Picano E 
Published: October 2022

Abstract

Background
Stress echocardiography (SE) is based on regional wall motion abnormalities and coronary flow velocity reserve (CFVR). They recognise different and complementary pathophysiological targets, and show independent and incremental value in predicting survival [1]. The approach based on machine-learning (ML) has the recognised potential to identify unsuspected patterns, and this can be especially relevant in the field of risk stratification by cardiac functional stress testing due to multiple parameters used in comprehensive stress testing and the variable weight of covariates [2].

Aim
To assess SE outcome data analysis with ML approach.

Methods
We included 6,881 prospectively recruited and retrospectively analyzed patients (median age 67 years, IQR 59–74) with suspected (n=4,279) or known (n=2,602) coronary artery disease submitted to clinically-driven dipyridamole SE in 5 Italian institutions (Figure 1). The primary outcome measure was all-cause death. A Random Forest Survival model has been implemented to model the survival function according to the patient's characteristics. The Random Forest predicted response dependency on covariates has been investigated by reporting the variable dependence and the partial dependency plot (Figure 2). A web application was developed to predict the survival function according to the patients' characteristics. The external validation cohort was made of additional 1,002 patients recruited by a single, independent center in the same time period.

Results
During a median duration of follow-up of 3.4 years (IQR 1.6–7.5), 814 (12%) patients died. The mortality risk was higher for patients aged more than 60 years, resting ejection fraction &lt;60%, resting WMSI, positive delta WMSI scores, and CFVR &lt;3.0. The C-index performance (perfect prediction=1) was 0.79 in the internal validation cohort and 0.81 in the external, independent validation data set. Survival functions for individual patient were easily obtained with an open-access web-app.

Conclusion
An ML approach can be fruitfully applied to outcome data obtained with SE. Survival showed a constantly increasing relationship between survival and CFVR &lt;3.0 and stress-rest wall motion score index &gt;0. Since processing is largely automated, this approach can be easily scaled to larger and more comprehensive data sets to further refine stratification, guide therapy and be ultimately adopted as an open-source on-line decision tool.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The study was partially funded by CNR-MIUR (National Research Council, Italian Ministry of University and Research) Ageing subproject.
Haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise test in patients with ANOCA (SESPASM)
Authors: Dedic S , Boskovic N , Giga V , Nedeljkovic I , Tesic M , Jovanovic I , Aleksandric S , Beleslin B , Ciampi Q , Picano E , Djordjevic Dikic A 
Published: October 2022

Abstract

Introduction
In patients with angina and non-obstructed coronary arteries (ANOCA), functional dysregulation such as epicardial coronary spasm and microvascular dysfunction (microvascular spasm and /or impaired microvascular dilatation) frequently coexist.
The aim was to analyse haemodynamic indicators of arteriolar dysregulation during combined hyperventilation and exercise stress echo test in patients with ANOCA.

Methods
In a prospective study we enrolled 38 patients (56±13 years, 31 females) with ANOCA, proven by normal coronary angiogram. Stress echocardiography protocol with Doppler measurements of coronary flow consisted of hyperventilation test for spasm provocation (HYP, respiratory rate of 30 per min for 5') followed by supine bicycle exercise test (HYP+EXE) for assessment of endothelium dependent function. Adenosine test was done (ADO 140 mcg/kg in 1 min) for estimation of endothelium independent vasodilatation. Coronary flow velocity (CFV) was assessed in distal LAD by Transthoracic Doppler echocardiography at the end of the each stage of the test. Abnormal response to HYP was a CFV ratio (stress/rest) &lt;1.0 (vasoconstrictor response). CFV ratio at peak HYP+ EXE was an indicator of endothelial dependent vasodilatation (&lt;2 blunted response). An abnormal response to ADO was a CFV reserve &lt;2.0 (blunted vasodilatory response).

Results
The double product increased during HYP in comparison to rest (13263 vs 10321, p&lt;0.001), and further increased with EXE (23817 vs HYP, p&lt;0.001). Chest pain was present in 6 pts during HYP, and in additional three pts during HYP+EXE (15.8% vs 23.7%, p=0.25). ST segment depression was present in 6 pts during HYP and 23 during HYP+EXE (15.79% vs 60.52%, p&lt;0.001). Wall motion abnormality was provoked with HYP in three pts (7.89%) and in ten (26.3%) with HYP+EXE (p=0.016). CFV ratio was abnormal for vasoconstriction during HYP in 16 (42.1%) and blunted in 23 (60.52%) pts during HYP+EXE (Fig 1). Vasodilation during ADO was preserved in all patients, but one. There was significant difference between CFV reserve during HYP+EXE vs ADO (1.98±0.49 vs 2.53±0.43 respectively, p&lt;0.001) (Fig. 2).

Conclusion
Our results indicate that HYP induce microvascular dysfunction with vasospastic component which is reflected in reduced CFV ratio. This prevents the normal hyperemic response during EXE in more than a half of patients. Endothelial independent vasodilatation during ADO hyperemia was perserved in all patients, excluding structural microvasculature remodeling. HYP+EXE provocation with noninvasive measurement of coronary flow is a promising test for assessing mechanism of arteriolar dysregulation in ANOCA patients.

Funding Acknowledgement
Type of funding sources: None.
Three-dimensional left and right atrioventricular coupling indices as prognostic markers in heart failure with reduced ejection fraction
Authors: Vijiiac A E , Scarlatescu A , Verinceanu V , Cojocaru C , Petre I , Onciul S , Dorobantu M , Vatasescu R 
Published: October 2022

Abstract

Background
While left atrial and left ventricular functional parameters are established prognostic markers in heart failure (HF), recent studies suggest that parameters assessing the atrio-ventricular interaction are better predictors. Left atrioventricular coupling index (LACI) assessed with cardiac magnetic resonance is an emerging outcome predictor in HF patients, however its assessment by three-dimensional (3D) echocardiography hasn't been studied so far. Moreover, the role of the right atrioventricular coupling index (RACI) in HF remains to be established.

Purpose
We sought to evaluate the LACI, RACI and combined left and right atrioventricular coupling index (CACI) with 3D echocardiography in a cohort of patients with HF and reduced ejection fraction (HFrEF) and to assess their prognostic role.

Methods
We prospectively enrolled 60 consecutive patients with HFrEF in sinus rhythm, who underwent two dimensional and 3D echocardiographic acquisitions. LACI was calculated as the ratio between 3D left atrial and 3D left ventricular end-diastolic volumes. RACI was calculated as the ratio between 3D right atrial and 3D right ventricular end-diastolic volumes. CACI was defined as the sum between LACI and RACI. Patients were followed for major adverse cardiac events (MACE), defined as a composite endpoint of cardiac death or HF decompensation requiring hospitalization.

Results
After a mean follow-up of 19±9 months, 33 patients reached the endpoint. Patients with MACE had higher LACI (33.5±21.1% vs. 19.9±12.4%, p=0.003), higher RACI (33.6±23.6% vs. 20.8±13.8%, p=0.01) and higher CACI (67.0±38.0% vs. 40.7±24.4%, p=0.002) – suggestive of atrioventricular decoupling. In ROC analysis, CACI had the best AUC for event prediction (AUC=0.750, p=0.001, cut-off=42.8%, Sen=69.7%, Spe=77.7%), followed by LACI (AUC=0.745, p=0.001, cut-off=20.4%, Sen=72.7%, Spe=70.4%), and then RACI (AUC=0.717, p=0.004, cut-off=18.6%, Sen=75.8%, Spe=70.4%).
In unadjusted Cox regression, all three atrioventricular coupling indices were predictors of MACE: HR=3.30 [95% CI, 1.52–7.14], p=0.002 for LACI, HR=4.54 [95% CI, 2.03–10.17], p&lt;0.001 for RACI, HR=3.87 [95% CI, 1.82–8.23], p&lt;0.001 for CACI. A multivariable model was constructed using well-established event predictors in HFrEF: age, global longitudinal strain of the left ventricle, global longitudinal strain of the right ventricular free wall and pulmonary artery systolic pressure. All three atrioventricular coupling indices remained independent predictors of MACE in multivariable regression: HR=3.11 [95% CI, 1.36–7.14], p=0.007 for LACI, HR=4.38 [95% CI, 1.84–10.41], p=0.001 for RACI, HR=3.98 [95% CI, 1.75–9.03], p=0.001 for CACI.

Conclusion
Greater 3D LACI, RACI and CACI, reflecting atrioventricular uncoupling, are all independent prognostic markers in HFrEF.

Funding Acknowledgement
Type of funding sources: None.
The association between frailty and physical performance in elderly patients with heart failure
Authors: Jin U , Lee C J , Yoon M , Ha J , Oh J , Park S , Lee S H , Kang S M 
Published: October 2022

Abstract

Background
Frailty is known to be an important prognostic indicator in heart failure (HF). The Korean version of the frail scale for Koreans (K-FRAIL) has been developed and verified. The purpose of this study is to analyze the relationship between the K-FRAIL scale and physical performance, including muscular fitness and aerobic capacity in patients with HF.

Methods
This study included 143 HF patients aged over 65 years from a single tertiary hospital. In these subjects, muscular fitness was assessed using the handgrip test and knee extensor strength measurement, and aerobic capacity was assessed by cardiopulmonary exercise test and 6-minute walk test. Frailty status was measured using the K-FRAIL questionnaire and was classified as robust (K-FRAIL scale: 0), prefrail (1–2), and frail (3–5).

Results
Mean age of participants with robust (N=37), prefrail (N=75), and frail (N=31) were 72.5, 73.5, and 76.3 years, respectively. There was no difference in sex and left ventricular ejection fraction (LVEF) among groups, but the estimated glomerular filtration rate (eGFR) was significantly lower as frailty status increased (75.6±17.2 vs. 70.0±20.5 vs. 56.1±23.7 mL/min/1.73 m2; P&lt;0.001). Hand-grip strength and knee extensor muscle strength did not differ among groups. However, peak oxygen consumption (peak VO2; 22.8±5.0 vs. 19.3±4.6 vs. 16.9±4.7 mL/kg/min, P&lt;0.001) and 6-min walk distance (458.4±68.2 vs. 404.5±92.3 vs. 311.2±120.5 m; p&lt;0.001) significantly decreased according to frailty severity. In multivariate regression analysis adjusted for age, sex, haemoglobin, eGFR and LVEF, peak VO2 (β=−0.311; P=0.002) and 6-min walk distance (β=−0.384; P&lt;0.001) showed a significant inverse association with the K-FRAIL scale. With the cut-off value from receiver-operating characteristic curve analysis, peak VO2 (hazard ratio, 5.08; p=0.023) and 6MWT (hazard ratio, 3.99; p=0.020) were independent predictor of frailty according to K-FRAIL scale.

Conclusion
In elderly HF patients, physical performance differs according to frailty status, peak VO2 and 6-min walk distance correlates with the K-FRAIL scale better than muscular fitness.

Funding Acknowledgement
Type of funding sources: None.
Main results of the first Brazilian Registry of Heart Failure (BREATHE)
Authors: Albuquerque D C , Barros E Silva P G , Lopes R D , Hoffmann C , Nogueira P R , Reis H , Nishijuka F A , De Figueiredo Neto J A , De Souza Neto J D , Rohde L E P , Simoes M V , Rocha R M , Moura L Z , Marcondes-Braga F G , Mesquita E T 
Published: October 2022

Abstract

Background
Heart failure represents a common cause of hospitalization associated with poor short-term clinical outcomes. Little is known about the long-term prognosis of these patients in Latin America.

Methods
The rationale and design of the study were previously published (1). Briefly, BREATHE was the first nation-wide prospective observational study that included patients hospitalized due to acute heart failure in Brazil. In-hospital management as well as 12-month clinical outcomes were assessed. Patients were included during two time periods: from February 2011 to December 2012 (BREATHE I) and from June 2016 to July 2018 (BREATHE Extension). Adherence to evidence-based therapies was also evaluated.

Results
A total of 3,013 patients were included in 71 centers in Brazil. The median follow-up was 346 days. The BREATHE population included 39.3% of women, had a mean age of 65.2 (± 15.6) with a mean ejection fraction of 39.7% (± 17.5). Among the comorbidities, systemic arterial hypertension was the most common, present in almost 75% of the sample. At hospital admission, 83.8% of patients had clear signs of pulmonary congestion and the main cause of decompensation was poor adherence to heart failure medications, representing 27.8% of cases. Among patients with reduced ejection fraction, the concomitant use of renin-angiotensin-aldosterone inhibitors, beta-blocker and spironolactone at hospital discharge was 44.5% and decreased to 35.2% after 3 months (p&lt;0.01). Mortality rate at 12 months was 28.9 for every 100 patient years with 26.2% readmission at 90 days and 46.4% at 365 days. The most common etiology of heart failure was ischemic disease (Figure 1) but the worst prognosis was associated with Chagas disease (Figure 2) including an analysis of a composite outcome encompassing death, myocardial infarction, stroke or cardiac arrest after discharge.

Conclusions
In this large national prospective registry of patients hospitalized with acute heart failure, mortality and readmission were higher than what have been reported globally. Poor adherence to evidence-based therapies was a common both at hospital discharge and 1-year of follow-up.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Brazilian Society of Cardiology
Midodrine in treatment of post coronary revascularization vasoplagia; pilot, open label, assessor blinded randomized clinical trial
Authors: Sheikhy A , Ziaoddini M , Navid H , Ahmadi-Tafti H , Hosseini K 
Published: October 2022

Abstract

Purpose
Post cardiac surgery hypotension and inotrope dependence are among major causes of prolonged intensive care unit (ICU) stay. Besides routine managements, catecholamine inotrope-vasopressors are the traditional treatment. However, there is an increasing interest to catecholamine-sparing agents, such as Midodrine, oral alfa1 agonist, in patients with vasoplegia. Up to now there are no randomized study with midodrine on post cardiac surgery patients.

Material and method
In this pilot, open label, assessor blind, randomized clinical trial from June 2020 to December 2021, 65 patients with refractory (more than 24 hours inotropes) hypotension after coronary revascularization were included. Patients were randomly assigned to receive Midodrine add-on therapy (10 mg stat and 5 mg po every 12 hours) or placebo add-on routine treatment. The primary outcome was liberation time from IV inotrope-support. Secondary outcomes were ICU admission time and total vasopressor dosage after randomization.

Results
32 patients enrolled in Midodrine group, with a mean age of 60.72, and 33 patients received placebo with mean age of 63.27. Median liberation time from inotrope was 27 hours in Midodrine group and 49 hours in placebo group (p=0.022). ICU admission time for Midodrine and placebo groups were 115 and 121 hours, respectively (p=0.990). Total vasopressor dosage after randomization were similar in two studied groups, 4352 μg in Midodrine group and 5637 μg in placebo group (p=0.405). No adverse event was observed in Midodrine group.

Conclusion
Midodrine add-on inotrope therapy was a safe medication with appropriate compliance in ICU admitted patients after cardiac surgery, which seems to decrease the inotrope dependent time.

Funding Acknowledgement
Type of funding sources: None.
Early Intervention with Impedance-guided Heart Failure Management Improves Long-term Outcome: insights From the IMPEDANCE-HF Trial
Authors: Kleiner Shochat M , Fudim M , Kazatsker M , Kleiner I , Weinstein J M , Panjrath G , Kobo O , Roguin A , Meisel S 
Published: October 2022

Abstract

Background
Lung-impedance (LI) guided treatment of heart failure (HF) patients was shown to improve clinical outcomes.

Objectives
To perform a post-hoc analysis of the IMPEDANCE-HF extended trial in order to explore the mechanism underlying the improved outcome of the LI-guided compared with conventional therapy of HF patients.

Methods
The study included 290 HF patients with LVEF ≤45% randomized 1:1 to LI-guided or conventional therapy. The normal LI (NLI), representing the dry lung status, was calculated upon enrollment. The level of pulmonary congestion (LPC) was represented by ΔLIR= [(measured LI/NLI)-1] × 100%.

Results
There were 11473 outpatient visits in the LI-guided group and 10245 visits in the control group during follow-up, or 15.5 and 15.9 visits/patient×year, respectively (p=0.74). The LI-guided patients were on average less congested during follow-up than those in the control group (by 20%, p&lt;0.01). Multivariate regression analysis showed that the likelihood of hospitalization for HF [hazard ratio (HR): 0.62, 95% confidence interval (CI): 0.52–0.72, p&lt;0.01) and of all-cause mortality (HR: 0.83, 95% CI: 0.70–0.98, p=0.03] were lower in the LI-guided group than in the control group. In the LI-guided group, diuretic up-titration was 2-fold more frequent and at an earlier timepoint and at a 21% lower LPC (p&lt;0.01). In both groups the diuretic response was more prominent when up-titration was done at a lower LPC (p&lt;0.01).

Conclusion
LI-guided diuretic titration prompted earlier, and more frequent diuretic dose increase when the LPC was only beginning to increase and this resulted in a greater decongestive response with better clinical outcomes.

Funding Acknowledgement
Type of funding sources: None.
Left atrial coupling index predicts heart failure and atrial fibrillation in the general population
Authors: Ravnkilde K , Skaarup K , Lassen M C H , Johansen N D , Benfari G , Nistri S , Jensen G B , Schnohr P , Moegelvang R , Biering-Soerensen T 
Published: October 2022

Abstract

Background
It is well known that left atrial (LA) function and size can provide significant information regarding the risk of atrial fibrillation (AF) and heart failure (HF). The ratio of LA volume index and tissue doppler imaging a' (peak myocardial velocity of the left ventricle in late diastole exposing the atrial contraction) provides the LA volumetric/mechanical coupling index (LACi). LACI is a novel echocardiographic measurement which combines information of LA size and function in one measure with limited previous investigation.

Purpose
The aim of the present study was to investigate the prognostic value of LACi in relation to incident HF and AF in the general population.

Methods
The present study included 4,003 participants from a prospective general population. All participants were examined with echocardiography. Incident HF and AF were investigated as separate outcomes. Exclusion criteria were AF and/or HF at baseline. LACi was calculated as the index of LAVI (left atrial volume index) and peak tissue velocity at late diastole measured with pulsed wave Doppler at the septal base of the left ventricle.

Results
Mean age was 56±17 years, 57% were female, and median LACi was 2.3 [IQR: 1.8, 3.0]. The median follow-up time was 5.4 [IQR: 4.5, 6.3] years. A total of 82 and 164 developed HF and AF during follow-up, respectively. Median LACi was significantly higher among participants developing HF (2.6 [IQR: 2.1, 3.8], P&lt;0.001) and AF (2.8 [IQR: 2.1, 4.1], P&lt;0.001) compared to those who remained event free (2.3 [IQR: 1.8, 3.0]). Multivariable Cox proportional hazard regression models were constructed and adjusted for gender, age, smoking status, hypercholesterolemia, diabetes mellitus, ischaemic heart disease at baseline, hypertension, left ventricular ejection fraction and left ventricular diastolic function (E/e'). LACi was an independent predictor of incident HF and of AF in both univariable and multivariable Cox regression models (Figure 1). LACi remained a significant predictor of both HF and AF in a sensitivity analysis with subgroups in which LAVI was normal and enlarged, respectively (Figure 1).

Conclusion
LACi is an independent predictor of HF and AF in the general population.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Danish Heart Foundation and The Metropolitan Region of Denmark.
Prognostic value of rest B-lines with the simplified 4-site scan for predicting survival: incremental value over transthoracic echocardiography
Authors: Merli E , Ciampi Q , Arbucci R , Cortigiani L , Zagatina A , Wierzbowska-Drabik K , Djordjevic-Dikic A , Amor M , Boshchenko A , Rodriguez-Zanella H , Barbieri A , Haberka M , Gaibazzi N , Simova I , Picano E 
Published: October 2022

Abstract

Background
Lung ultrasound (LUS) detects pulmonary congestion as B-lines at rest.

Methods
After preliminary exclusion of 154 patients lost to follow-up, we analyzed transthoracic echocardiography (TTE) plus LUS (4-site simplified scan) data in 5165 subjects (age 64±11 years) referred to 19 certified centers of 9 countries for known or suspected coronary artery disease (n=3891, 75%), dyspnea (n=591, 12%), or screening in asymptomatic patients with risk factors (n=667, 13%). We analyzed the anterior and lateral hemi-thoraces, scanning from mid-axillary to mid-clavicular lines on the third intercostal space. B-lines score ranged from 0 (normal) to 40 (severely abnormal). By selection, follow-up information was available in all. All-cause death was the predetermined end-point.

Results
Feasibility of B-lines was 100% in all subjects. B-lines (median) were 0.1 [0–1]. Rest B-lines (≥2) were present in 863 patients (16.7%). Ejection fraction was 61±10%. After a median follow-up of 690 (Interquartile range 420–1065) days, 96 all-cause deaths occurred. Two-year mortality was 3.6% in patients with and 1.5% in patients without B-lines (p&lt;0.001) and increased progressively with the increasing number of B-lines, from 2.4% in mild (2–4, n=630), 5.0% in moderate (5–9, n=160) and 8.2% in patients with severe (≥10, n=73) B-lines (see figure). At multivariable analysis, rest B lines (HR 1.812, 95% CI: 1.165–2.916, p=0.008) and ejection fraction (HR 0.987, 95% CI: 0.976–0.998, p=0.020) were independent predictors of all-cause death, in addition to age (HR 1.045, 95% CI: 1.023–01.067, p&lt;0.001) and diabetes (HR 1.643, 95% CI: 1.079–2.503, p=0.021).

Conclusion
In all-comers referred for TTE, resting B-lines assessed by focused LUS with the simplified 4-site scan are detected in 1 out of 4 patients with symptos or coronary risk factors and are associated with worse survival. The severity of pulmonary congestion predicts the severity of outcomes. The prognostic value of resting B-lines is independent and additive over standard clinical and TTE predictors such as diabetes and ejection fraction. Focused LUS for pulmonary congestion can easily be incorporated in standard TTE examination.

Funding Acknowledgement
Type of funding sources: None.