bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic power of a new index of right ventricle-pulmonary artery coupling based on right ventricular volumes in patients with secondary tricuspid regurgitation
Authors: Cascella A , Gavazzoni M , Muraru D , Heilbron F , Caravita S , Tomaselli M , Parati G , Badano L P 
Published: October 2022

Abstract

Background
Although echocardiographic surrogates of right ventricular -arterial coupling (RVAC) have been reported to be associated with outcome in patients with moderate or severe secondary tricuspid regurgitation (STR), pulmonary artery systolic pressure (SPAP) is difficult to be estimated using echocardiography in patients with severe STR.

Purpose
Accordingly, we evaluated the predictive power of indexes of RVAC obtained using RV volumes measured using three-dimensional echocardiography (3DE).

Methods
We prospectively enrolled 180 patients with moderate or severe STR and complete two-dimensional, Doppler and 3DE data. The composite endpoint of death for any cause and heart failure hospitalization was used as primary outcome.

Results
After a median follow up of 24 months (IQR: 2–48), 72 patients (40%) reached the primary endpoint. Most of the echocardiographic parameters of RV function were associated with outcomes. Among the different parameters of RVAC, the receiver operating curve (ROC) analysis selected the ratio between (RV stroke volume [SV]-RegVol)/ RV End-systolic volume (ESV) (i.e. the RV forward SV/ESV) as the best predictor of the combined endpoint (AUC 0.80 [IC 95% 0.73–087]), with a threshold value of 0.49.
Event-free survival of patients with RV forward SV/ESV higher and lower 0.49 has been performed (Figure 1).
Multivariable Cox proportional hazards models were constructed (Figure 2). Adding sequentially the 3D-RVEF, TAPSE/SPAP and the forward RV SV/RV ESV on top of a basal model made of TR severity, New York Heart Association (NYHA) functional class and tricuspid anulus plane systolic excursion (TAPSE), the χ2 of the model increased from 40 to 43 (p=0.13) by adding 3D RVEF, from 43 to 46 (p=0.04) by adding TAPSE/SPAP, and from 46 to 51 (p=0.02) by adding RV forward SV/ESV. Severe TR (HR 3.53 [CI 95%: 1.84–6.78], p&lt;0.001) and RV forward SV/ESV &lt;0.49 (HR 2.45 [CI 95% 1.16–5.18], p=0.02) were the only parameters independently associated with outcome.

Conclusions
The RV forward SV/ESV is an index of RVAC obtained by 3DE which is independent from SPAP and it is strongly associated with the occurrence of death or heart failure hospitalization in patients with STR.

Funding Acknowledgement
Type of funding sources: None.
Tricuspid valve geometry alterations in different aetiologies of functional regurgitation: 3D echocardiography study
Authors: Krivickiene A , Verikas D , Kreckauskiene R , Gujyte G , Vaskelyte J J , Ereminiene E 
Published: October 2022

Abstract

Introduction
Evaluation of tricuspid annulus (TA) has many challenges due to its complex three-dimensional shape. The 3D-echocardiography is a gold standard method for accurate assessment of tricuspid valve (TV). Studies investigating TV geometry in different aetiologies of tricuspid regurgitation (TR) are still scarce.

Aim
The aim was to clarify the TV geometry characteristics in different aetiologies of functional TR (FTR).

Methods
Prospective observational cohort study enrolled 107 patients with functional moderate or severe TR and 10 healthy controls. FTR patients were divided into two groups according to the different aetiology of FTR: 1. TR caused by dominant left-sided valvular pathology (LSVP) – 68 patients (pts); 2. TR caused by precapillary pulmonary hypertension (PH) (invasively measured pulmonary capillary wedge pressure &lt;15 mmHg) – 39 pts. Pts with ischemic heart disease (assessed by coronary angiography) were excluded from the analysis. The 3D-transthoracic echocardiography was performed and included the following parameters: the systolic and diastolic 4-chambers (septal–lateral), 2-chambers (anterior–posterior), major axis TA diameters, TA area, perimeter, leaflets tenting height and volume. All parameters have been indexed to body surface area. The 3D TV analysis was made using 4D Auto TVQ quantification software package (GE Healthcare, USA). The statistical analysis was performed using SPSS statistical software.

Results
Study cohort included 66% females; mean age was 65±11 years. TR severity, measured quantitatively, did not differ between FTR groups (ERA – 32±18 in LSVP vs 35±18 mm2 in PH group, p=0.219). The distribution of echocardiography parameters in study groups are shown in Table 1. All the 3D TV parameters were increased in both FTR groups when compared to controls. Precapillary PH was associated with larger leaflets tenting height, volume, and more increased indices of TA systolic and diastolic septal-lateral and major axis diameters. LVSP aetiology was associated with higher TA sphericity index.

Conclusions
Tricuspid valvular geometry differs between different aetiologies of functional TR. The implementation of 3D echocardiography is useful in the determination of TV geometry changes and might provide valuable tools in the evaluation of patients with functional TR.

Funding Acknowledgement
Type of funding sources: None.
Low major bleeding, pump thrombosis and death rates in continuous flow left ventricular assist devices patients with good anticoagulation control
Authors: Janssen E , Van Rein N , Den Exter P L , Palmen M , Beeres S L M A , Jukema J W , Tops L F 
Published: October 2022

Abstract

Background
Continuous-flow left ventricular assist device (CF-LVAD) patients require anticoagulation with vitamin K antagonists (VKAs). Good versus suboptimal anticoagulation control expressed as high versus low time in target range (TTR) of international normalized ratio results in less clinical events in atrial fibrillation patients. However, data in CF-LVAD patients are lacking.

Purpose
To study the association between TTR and clinical events in patients with CF-LVAD as destination therapy.

Methods
Single-centre cohort study in patients receiving CF-LVAD between 2010–2021. Patients were followed from start of VKAs until outcome or end of follow-up. Outcomes were combined major adverse events, thromboembolisms, major bleedings, neurologic events and all-cause mortality. The TTR (low vs. high; &lt;50% vs. &gt;50%) was calculated during the overall study period and over 1-month periods by the Rosendaal-method. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated by Cox regression with time-dependent covariables, adjusted for confounding.

Results
74 patients were included; median age 63 years [interquartile range 58–68], 77% males and 60%ischemic heart failure. During 191 years follow-up, 39 combined major adverse events, 14 thromboembolisms, 21 major bleeding, 22 neurologic events and 38 deaths occurred. For 1-month periods, high TTR was associated with less combined major adverse events (HR 0.3 95% CI 0.2–0.7), major bleeding (HR 0.4 95% CI 0.2–1.1), thromboembolism (HR 0.3 95% CI 0.1–1.3) and death (HR 0.2 95% CI 0.1–0.5) (Table 1). Results considering the overall study period were similar.

Conclusion
Good anticoagulation compared with suboptimal control during 1-month and the overall study period in CF-LVAD patients with destination therapy is associated with lower rates of combined major adverse events, major bleedings, pump thrombosis and death.

Funding Acknowledgement
Type of funding sources: None.
4D strain analysis in murine echocardiography facilitates quantification of myocardial infarction
Authors: Schreiber C , Ballmann F S , Mehrkens D , Geissen S 
Published: October 2022

Abstract

Introduction and rationale
Myocardial infarction (MI) can be surgically induced in mice. Accurate measurement of infarction size (IS) is regularly used as an experimental readout. Established methods for IS consist of macroscopic or histological staining of the left ventricle (LV). These methods do not allow for further molecular analysis and do not characterize the functional state of the LV. Echocardiographic analysis of the LV is often performed in MI studies, yet most studies rely on 2D-B-Mode or M-Mode imaging. Here, the extent of the infarction can easily be misjudged. Therefore, we wanted to develop a new strategy to reliably estimate IS in echocardiography.

Methods and results
Echocardiography was performed at baseline conditions and 7 days after MI induction using a Vevo 3100 sonography device with a MX550S transducer (slice thickness for 4D datasets: 150μm). For 4D strain analysis, a custom-made software tool was used to trace the endocardial surface of the LV. The method was checked for inter-observer reliability which was excellent for volumetry and estimation of systolic function (correlation of ejection fraction between observers: r=0.9414, p&lt;0.0001). Surface area strain was computed and the area that displayed a surface area strain &gt;−10% was considered infarcted. IS measured by 4D surface area strain was correlated with ejection fraction (r=−0.510, p=0.002) and IS estimated by triphenyl tetrazolium chloride staining (r=0.582, p=0.005).

Conclusion
4D strain analysis based estimation of IS is a reliable method for functional and morphological characterization of infarcted hearts. Other than established IS measurements, it allows for additional molecular analyses within the same individuum and can be used to monitor growth or reduction of the akinetic area over time. It therefore emerges as a powerful tool for murine MI studies.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): DFG - GRK 2407 (360043781)
Outcomes of patients after repeat heart transplantation – insights from the UNOS database
Authors: Kampaktsis P , Doulamis I , Tzani A , Ruck J , Zhou A , Shah M , Kilic A , Kourek C , Briasoulis A 
Published: October 2022

Abstract

Background
Cardiac graft failure may require repeat heart transplantation (HTx). Outcomes of patients that undergo repeat HTx have not been well described.

Methods
We compared patients that received repeat HTx with patients that received initial HTx by inquiring the United Network for Organ Sharing database between 2015–2021. The primary endpoint was all-cause mortality.

Results
A total of 19,805 HTx patients were included in the study. Patients that underwent repeat HTx (n=578, 3%) were younger (43.8±15.3 vs. 53.7±12.7 years, p&lt;0.001) with lower body mass index (26.8±5.3 vs. 27.6±4.9 kg/m2, p&lt;0.001) and worse renal function (Cr 1.8±1.4 vs. 1.4±0.9 mg/dl). Patients with repeat HTx had increased risk for 1-year mortality (hazard ratio 1.49 [1.16–1.90], p=0.002) compared to patients with initial HTx after adjusting for age, ethnicity, use of left ventricular assist device, UNOS recipient status, diabetes, ischemic time, donor age and predicted heart mass mismatch (Figure 1). Results did not change with the new allocation system (10/2018).

Conclusion
Repeat HTx occurred in 3% of a contemporary UNOS cohort and carried an increased and independent risk for mortality.

Funding Acknowledgement
Type of funding sources: None.
ADONHERS (Aged DONor HEart Rescue by Stress echo) protocol for heart donation from marginal donor hearts: monocentric retrospective study on recipients survival after 10-year follow-up
Authors: Mandoli G E , Barilli M , Soviero D , Ghionzoli N , Maccherini M , Bernazzali S , Natali B , Cavigli L , D'Ascenzi F , Focardi M , Pastore M C , Valente S , Cameli M 
Published: October 2022

Abstract

Purpose
Amelioration of therapies and increased survival in heart failure (HF) is leading to a growing number of patients affected by advanced HF, with an overall 1-year prognosis ranging from 25 to 75%. The gold standard treatment for end stage HF is heart transplantation (Htx), but lack of organs donors remains an important limitation. Marginal hearts can potentially improve and be utilized after a re-evaluation by “aggressive” assessment of donor left ventricular dysfunction, with an important increase of utilization rates (from 38–59%) in the latest years. In our study we analysed if recipients of marginal donor hearts, selected by dipyridamole stress echocardiography, had different outcome compared to recipients with acceptable donor hearts.

Methods
Data collected from 2006 and 2014 of patients who received orthotopic Htx were retrospectively analysed. Clinical, laboratory and instrumental features were evaluated and patients with homogenous baseline characteristics were selected to reduce biases among the two groups. Dipyridamole stress echo was performed on donors &gt;55 years old or &lt;55 with comorbidities/mildly dysfunctional left ventricle.

Results
Twenty-two recipients were included (eleven patients with a marginal donor heart, group 1, and eleven with acceptable donor heart, group 2). Mean donors age was 41±23, 45±29 years for group 1 vs 36±12 for group 2. The average follow-up was 113 months. Age, cardiovascular risk and morpho-functional characteristics of the left ventricle were comparable between the two population (P&gt;0.05) (see Table 1). Left atrial size was significantly higher in marginal hearts (Optimal: p=0.007; Marginal: p=0.003). Optimal donors showed a higher impact of CAV (p=0.019) together with more elevated values of cholesterol and triglycerides (p=0.048 and p=0.012 respectively). No rejection differences were found between the two groups. Four patients deceased, 3 had received a standard donor heart and 1 was from the marginal donor group, with and overall median time to death of 124 months.

Conclusions
No mortality difference was detected among the two heart donor groups with a lower incidence of CAD in the marginal heart donor population. Our study shows how Htx from selected marginal donor heart can implement shortage of organs without difference in survival with acceptable donor hearts.

Funding Acknowledgement
Type of funding sources: None.
Monitoring of the lung fluid status in hospitalized COVID-19 patients for predicts outcome. Results of the IMPEDANCE-Corona Trial
Authors: Kleiner Shochat M , Mohsen J , Abu Rumi M , Hellou E , Abolil M , Singer C , Kazatsker M , Kobo O , Roguin A , Meisel S 
Published: October 2022

Abstract

Introduction
Prediction of the clinical deterioration in hospitalized COVOD-19 patients is an unmet goal.

Aim
To assess monitoring of lung fluid status of hospitalized COVID-19 patients as a tool to predict clinical respiratory deterioration and prognosis.

Methods
The present study population comprised 51 patients hospitalized in our medical center with COVID-19 infection. The lung fluid status of patients was monitored by repeat measurements the lung impedance (LI). The LI technique was found to be a very effective tool for monitoring and guiding the treatment of a heart failure patients. Decreasing LI reflects lung fluid accumulation. Clinical and laboratory parameters, chest X-ray (CXR) and LI level were recorded during hospitalization.

Results
Of the 51 patients hospitalized for COVID-19 infection (37 men and 14 women, 55.7±12.6 years old), 46 were discharged after successful treatment (Group 1) and 5 (9.8%) died during hospitalization (Group 2). The LI kinetics during hospitalization demonstrated a different pattern between groups (Figure 1, p&lt;0.01). In group 1 patients, a small LI decrease (−3.5±4.3%, p=0.7) during the first 4 days (median = 2.2 days, [Q1–3: 1–3.7 days]) of hospitalization was noted. Following this, LI increased progressively until discharge (+20.3±12.3%, p&lt;0.01). Among group 2 patients, LI decreased progressively during hospitalization. Mechanical ventilation was initiated at the eighth day [median = 8, Q1–3: 4–12 days] when LI decreased by 18.2±3.8% in comparison with the admission level (p&lt;0.01). Deaths occurred at 12.4±2.7 days (median = 12 days) after admission. Multivariate Cox regression analysis of clinical, laboratory and CXR variance has shown that the degree of LI decrease during hospitalization is the most reliable predictor of death (hazard ratio: 1.36 [1.04–1.79], p&lt;0.04).

Conclusions
The combination of progressively decreasing LI after 4 days of hospitalization for COVID-19 infection and an LI decrease &gt;15% is the most reliable predictor of death.

Funding Acknowledgement
Type of funding sources: None.
COVID-19 pandemic impact on heart failure epidemiology and outcomes in Poland. National database study
Authors: Zaleska-Kociecka M , Celinska-Spodar M , Podwojcic K , Maluchnik M , Walkiewicz D , Hryniewiecki T , Leszek P 
Published: October 2022

Abstract

Background
COVID-19 pandemic negatively affected patients' will to seek urgent medical treatment as well as and health service performance.

Purpose
The aim was to evaluate the impact of COVID-19 pandemic outbreak at the beginning of 2020 on heart failure epidemiology and outcomes in Poland.

Methods
The study is based on the Nationwide Polish Ministry of Health Registry, an administrative nation-wide database covering all heart failure patients in Poland who were beneficiaries of the public health sector between 2013 and 2021.

Results
After COVID-19 outbreak in 2020, significantly fewer patients presented to health service due to HF than in previous years (Fig. 1). Compared to 2019, the number of HF hospitalisations declined by 21% and outpatient visits by 10% in 2020.
Simultaneously, for the first time in the last decade, the trend in heart failure prevalence went down dropping by 3.7% (Fig. 1). The trend was driven by the greater reduction in ischaemic vs non-ischaemic HF prevalence (4.7% vs 1.3%)
The longstanding downtrend in heart failure incidence accelerated markedly in 2020, decreasing by 20% between 2019 and 2020, compared to average fall of 8% in the previous decade (ranging between 4.1–12.9%). Likely, the drop was mainly attributable to the decline in the ischaemic HF incidence (23% vs 15.3% drop in nonischemic HF).
The average in-hospital mortality due to HF in 2020 was higher compared to 2019 (12.9% vs 11.02%). As many as 1.18% of patients died on the day of admission in 2020, contrary to 0.94% in 2019 which accounts to 25% increase. Monthly distribution of in-hospital mortality aligned with peaks of COVID-19 waves (Fig. 2).

Conclusion
The study shows unfavorable changes in HF epidemiology and outcomes due to the pandemic. The drop in prevalence and incidence seems to be associated with lower patient influx to the health service. It is unknown whether patient non-occurrence resulted from patients' actions or preoccupation of the health service with the pandemic. At the same time, a marked rise in in-hospital mortality was noted, with an over 25% increase in the number of deaths on the day of admission that could potentially reflect a more advanced disease state.

Funding Acknowledgement
Type of funding sources: None.
Effectiveness of a disease management program in heart failure is influenced by patient's prior hospitalisation
Authors: Huynh Q , Marwick T H 
Published: October 2022

Abstract

Background
Hospitalization due to heart failure (HF) is a strong predictor of adverse outcomes. This study sought to what extent previous HF admissions may affect the success of a disease management program (DMP).

Methods
We prospectively enrolled 1363 consecutive HF patients, who were followed for 3 months post-discharge. Of these, 431 (31%) received a DMP (1-month duration, including post-discharge home visits, medication reconciliation, exercise guidance and early clinical review). Study outcomes were all-cause readmission or death at 30- and 90-day post-discharge. Previous HF admissions were collected from medical records.

Results
Of 1363 HF patients, death or readmission occurred in 386 (28%) at 30-day and 556 (41%) at 90-day post-discharge. Compared to 765 patients without any previous admission, the 143 patients with a previous HF admission in &gt;12 months had similar risks of readmission or death at 30-day and 23% higher risks at 90-day. The 420 patients who had a previous HF admission in ≤12 months had higher risks of the composite outcome both at 30-day (RR=1.47 [1.23–1.76]) and 90-day (RR=1.49 [1.30–1.69]). DMP was not associated with any reductions in adverse outcomes at 30-day and 90-day among patients with a previous HF admission in ≤12 months, but was significantly associated with up to a 75% reduction in risks at 30-day and a 50% reduction in risks at 90-day among those without an admission in ≤12 months. These findings were independent of all other factors.

Conclusion
Higher levels of attention should be focused on HF patients with a recent prior HF admission who have higher risks of post-discharge adverse outcomes and appear to be non-responsive to a DMP to reduce readmission.

Funding Acknowledgement
Type of funding sources: None.
Influence of the SGLT2 inhibitor empagliflozin on post myocardial infarction rat hearts
Authors: Damatto F C , Paschoareli G L , Rosa C M , Gomes M J , Pagan L U , Damatto R L , Rodrigues E A , Pontes T H , Reyes D R A , Cezar M D M , Oliveira L R S , Zornoff L A M , Rego A B G C , Okoshi M P , Okoshi K 
Published: October 2022

Abstract

Studies have shown that inhibition of the sodium glucose transporter protein 2 (SGLT2) reduces cardiovascular death in patients with heart failure and reduced ejection fraction. However, the mechanisms involved in the benefits of SGLT2 inhibitors are poorly understood.

Objective
To evaluate the effects of empagliflozin (EMP) on normal and post-myocardial infarction (MI) rat hearts.

Methods
Male Wistar rats (n=80) were assigned into four groups: Sham; Sham treated with EMP (Sham-EMP); myocardial infarction (MI); and MI treated with EMP (MI-EMP). EMP added to rat chow (5 mg/kg/day) was initiated 10 days after MI induction and maintained for 12 weeks. Echocardiogram was performed at the end of the experimental period. Markers of oxidative stress, energy metabolism, and respiratory complex activity were analyzed in left ventricular myocardium. Statistical analysis: ANOVA.

Results
Histological evaluation showed that EMP did not change infarct size. Cardiac structural and functional parameters did not differ between MI-EMP and MI groups. Myocardial oxidative stress, evaluated by lipid hydroperoxide concentration, was lower in MI-EMP than MI group (Sham 143±26; Sham-EMP 123±20; MI 183±29; MI-EMP 137±11 nmol/g tissue). Glutathione peroxidase was lower in the infarcted groups and did not differ between MI-EMP and MI (Sham 37.6±6.14; Sham-EMP 40.8±10.1; MI 27.7±6.61; MI-EMP 26.5±6.80 μmol/g tissue). Activity of the energy metabolism enzymes lactate dehydrogenase (Sham 45.2±6.65; Sham-EMP 41.1±9.33; MI 58.4±14.4; MI-EMP 55.7±10.1 nmol/mg protein) and citrate synthase (Sham 30.4±4.25; Sham-EMP 37.2±4.85; MI 45.8±8.47; MI-EMP 46.5±9.95 nmol/mg protein) was higher, and β-hydroxyacyl-CoA dehydrogenase (Sham 24.0±3.12; Sham-EMP 20.4±4.84; MI 16.9±4.81; MI-EMP 14.4±4.58 nmol/mg protein) lower in the infarcted groups with no differences between MI-EMP and MI. Respiratory complexes I and II, and ATP synthase did not differ between the infarcted groups.

Conclusion
Empagliflozin reduces myocardial oxidative stress independent of changes in antioxidant enzymes activity, energy metabolism, and respiratory complex activity in the myocardium of infarcted rats.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Fapesp, CNPq