bluuebunny/crossref_metadata_2025_split huggingface dataset:
Heart failure with mildly reduced ejection fraction: not a mid-range prognosis
Authors: Borges-Rosa J , Almeida J P L , Martinho S , Marques-Alves P , Oliveira-Santos M , Goncalves L 
Published: October 2022

Abstract

Introduction
Heart failure with mildly reduced ejection fraction (HFmrEF) has been recognized in the last heart failure guidelines of the European Society of Cardiology, replacing the concept of “midrange ejection fraction”. There is limited data regarding mortality outcomes of HFmrEF compared to heart failure with reduced (HFrEF) and preserved (HFpEF) ejection fraction.

Purpose
We aimed to evaluate whether HFmrEF has a different prognosis after an acute heart failure (AHF) episode, in a real-world contemporaneous southern European population.

Methods
We retrospectively studied 1026 patients admitted to our emergency department between November 2016 and December 2017 with discharge diagnosis of AHF. Median follow up was 5 months (IQR 3–11 months). Incidence of rehospitalization, cardiovascular (CV) and all-cause mortality were evaluated through multivariable logistic regression models and by Kaplan-Meyer survival curves.

Results
From all patients, 782 were categorized in HFrEF (34.1%), HFmrEF (19.4%) and HFpEF (46.4%). There was heterogeneity between groups. Compared to HFrEF, HFmrEF patients were older (80 [74–84] vs. 76 [67–82] years, p&lt;0.001), with lower prevalence of males (61.2% vs. 76.4%, p=0.004) and coronary artery disease (CAD) (35.5% vs. 47.6%, p=0.024), but higher rates of valvular heart disease (VHD) (48.0% vs. 29.6%, p&lt;0.001). Compared to HFpEF, HFmrEF subjects had higher prevalence of males (61.2% vs. 40.8%, p&lt;0.001) and CAD (35.5% vs. 13.2%, p&lt;0.001). At admission, patients with HFmrEF and HFrEF had similar serum creatinine e B-type natriuretic peptide values, but higher than the HFpEF group: 1.38±0.7 vs. 1.45±0.7 vs. 1.28±0.8mg/dL, p=0.019 and 701 [385–1191] vs. 1000 [494–1776] vs. 360 [214–717]pg/mL, p&lt;0.001, respectively. HFmrEF patients had higher rates of hospitalization (71.7% vs. 43.8%, p&lt;0.001), follow-up readmissions (27.6% vs. 18.7%, p=0.034), CV (11.8% vs. 5.0%, p=0.025) and all-cause mortality (25.7% vs. 14.9%, p=0.015), compared to HFpEF; no differences comparatively to HFrEF. There was no difference between groups regarding the length of hospitalization (9 [5–15] vs. 8 [5–15] vs. 10 [6–17] days, p=0.302). In multivariate logistic regression model adjusted for age, sex, SBP, CAD, VHD, creatinine, and BNP, HFmrEF increased the risk of CV (OR 2.9, 95% CI 1.2–6.7, p=0.016) and all-cause mortality (OR 2.1, 95% CI 1.2–3.9, p=0.011), but not follow-up readmissions (OR 1.7, 95% CI 0.9–2.9, p=0.059). Kaplan-Meier estimates of CV, and all-cause mortality are shown in Figure 1.

Conclusions
HFmrEF have a similar prognosis to HFrEF and worse than HFpEF, with more readmissions, CV and all-cause mortality, after an AHF episode.

Funding Acknowledgement
Type of funding sources: None.
Association between use of renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors and beta-blockers and outcome in real-world heart failure and mildly reduced ejection fraction
Authors: Stolfo D , Lindberg F , Lund L , Sinagra G , Dahlstrom U , Rosano G , Savarese G 
Published: October 2022

Abstract

Background
In heart failure with mildly reduced ejection fraction (HFmrEF) European guidelines recommend the use of antineurohormonal therapies with a low level of evidence (IIb C) based on data from subgroup and post-hoc analyses of randomized clinical trials (RCTs). Data from large and unselected real-world HFmrEF populations are lacking.

Purpose
To assess the association between renin-angiotensin system inhibitors/angiotensin receptor neprilysin inhibitors (RASI/ARNI) and beta-blockers and outcomes in HFmrEF.

Methods
Data from patients with HFmrEF (EF: 40–49%) from the Swedish HF Registry during 2000–2018 were considered. The association between each of RASI/ARNI and beta-blockers treatment and cardiovascular (CV)mortality/heart failure hospitalization (HFH) and all-cause mortality was assessed by Cox proportional hazard models in a 1:1 propensity score-matched cohort. Since propensity score (PS) matching might lead to a selection of the study population and reduction of the sample size, as consistency analysis Cox proportional hazard models were also fitted in the overall cohort adjusting rather than matching for PS.

Results
Of 12421 patients with HFmrEF (mean age 74±12 years, 64% males), 10419 (84%) received RASI/ARNI, 10941 (88%) received beta-blockers. Patients treated with both RASI/ARNI and beta-blockers were 9332 (75%), 2696 (22%) patients received one drug (9% RASI/ARNI, 13% beta-blockers) and 393 (3%) none. Main predictors of treatments use were younger age, female sex (only for beta-blockers), outpatient setting, referral to specialty care and nurse-led HF clinic. Lower NT-proBNP levels were associated with more use of RASI/ARNI but less use of beta-blockers. Better renal function was predictive of RASI/ARNI use. Comorbidities were associated with less use of treatments, in particular atrial fibrillation for RASI/ARNI, and COPD for RASI/ARNI and beta-blockers. In the matched cohorts including 3854 for RASI/ARNI analyses and 2940 patients for beta-blockers, RASI/ARNI (HR=0.90, 95% CI: 0.83–0.97) and beta-blocker (HR=0.82, 95% CI: 0.75–0.91) use were associated with a statistically significant lower risk of CV mortality/HF hospitalization (Figure 1) and of all-cause mortality (HR=0.72, 95% CI: 0.67–0.78 and HR=0.77, 95% CI: 0.70–0.85, respectively). Consistency analysis confirmed results.

Conclusions
RASI/ARNI and beta-blockers were largely used in this large real-world cohort of patients with HFmrEF to treat comorbidities. Their use was associated with lower risk of mortality/morbidity and the magnitude of the associations was somehow similar to what observed in subgroup/post-hoc analyses of RCTs. Our findings call for a fast implementation of guidelines recommendations on HFmrEF treatment.

Funding Acknowledgement
Type of funding sources: None.
Exercise oscillatory ventilation disturbances: finding order amongst chaos
Authors: Lopes Da Cunha G J , Rocha B , Rocha B , Maltes S , Maltes S , Freitas P , Freitas P , Gama F , Gama F , Andrade M J , Andrade M J , Aguiar C , Aguiar C , Moreno L , Moreno L , Durazzo A , Durazzo A , Mendes M , Mendes M 
Published: October 2022

Abstract

Background
Exercise Oscillatory Ventilation (EOV) during Cardiopulmonary Exercise Test (CPET) predicts prognosis in patients with Heart Failure (HF). In these patients, O2 consumption (VO2) oscillations have also been described, possibly secondary to circulatory delay. We hypothesize that in clinically meaningful EOV, cardiac output variation is mirrored by VO2 oscillation, which is then chronologically followed by a similar oscillation in minute ventilation (VE) (Figure 1). Accordingly, we aimed to assess whether this new definition surpassed that of classical EOV.

Methods
This is a single-centre cohort study of consecutive patients undergoing CPET from 2016 to 2018. Patients with LVEF &gt;50% were excluded. CPET was performed on a treadmill to the limit of tolerance. Data was collected as a rolling average of 20 seconds and a composite VE/time and VO2/time plot was created. Classical EOV was defined as three or more regular oscillations of the VE graph with a minimal average amplitude of five litters. The addition of exercise VO2-to-VE peak-to-peak ventilation asynchrony (EVA) to the previous criteria fulfilled the new definition. The primary endpoint was a composite of time to all-cause death, heart transplantation or HF hospitalization.

Results
Overall, 177 patients were enrolled (mean age 58±11 years, LVEF 34±9%), of whom 35 had EOV and 17 had EVA. Compared to those without EVA, patients with EVA had markers of more severe HF. During a median follow-up of 32 (21–42) months, 55 patients met the primary outcome (32 all-cause deaths, 15 heart transplants, 47 HF hospitalizations). In multivariate analysis, EVA was associated with a 2.5-fold increased risk of events (HR 2.489; 95% CI: 1.302–4.759; p=0.006), adjusted for peak VO2, VE to CO2 production ratio (VE/VCO2 slope) and LVEF. EVA outperformed EOV in predicting the primary endpoint at 1 year, with a similar sensitivity and higher specificity (96.2 vs. 83.2%). The rate of events between the subgroup of patients without EVA was similar regardless of presence of EOV, contrasting with a higher rate in the EVA subgroup (Figure 2).

Conclusion
EVA is a strong predictor of hard outcomes in a broad population with HF. The new definition may outperform that of classical EOV. The incidence and prognostic value of EVA in the management algorithm and risk stratification of patients with HF is worth being further explored.

Funding Acknowledgement
Type of funding sources: None.
A new cardiopulmonary exercise testing score for predicting heart failure events
Authors: Dias Ferreira Reis J P , Bras P , Goncalves A , Moreira R , Pereira Silva T , Timoteo A , Cruz Ferreira R 
Published: October 2022

Abstract

Background
Cardiopulmonary exercise test (CPET) provides several variables (V) that are strong predictors of events in patients (pts) with heart failure (HF).

Purpose
Our aim was to develop and evaluate the predictive power (PP) of a CPET-based score, comparing to that of the Heart Failure Survival Score – HFSS.

Methods
Retrospective evaluation of adult pts with HF submitted to CPET in a tertiary center. Pts were followed up for at least 1 year for the primary endpoint of cardiac death and urgent heart transplantation/ ventricular assist device implantation (MTV). The PP of several CPET V's was assessed using ROC curve analysis, which was used to define optimal threshold values for each V. A multiple regression analysis was performed to identify independent prognostic predictors and to determine the regression coefficient (β) for the Vs included in the model, each expressed dichotomously using the threshold value. According to β, a weight was assigned to each V and summed to calculate the composite score. ROC curves were compared using the Hanley and McNeil test.

Results
CPET was performed in 487 HF pts, with a mean age of 56±13 years, 79% were male. 46% of pts were of ischemic etiology, with a mean LVEF of 30±8%, a mean HFSS of 8.6±1.1 and a mean BNP value of 509±668pg/ml. The mortality rate during a mean follow-up of 21 months, was 19% (93pts) with 23 pts (5%) undergoing HT. The primary endpoint was reached by 55 (11%) pts. The variables with higher predictive power were OUES (AUC 0.796), ventilatory power (AUC 0.790), the partial pressure of end-tidal CO2 at the anaerobic threshold (PETCO2L – AUC of 0.787), the pVO2 (AUC 0.767) and heart rhythm (HR) during the test (AUC – 0.640). LVEF also presented a high predictive power with AUC of 0.755. The multivariate analysis revealed that pVO2, PETCO2L, AF, and LVEF were independent prognostic predictors. According to the β of these Vs, the equation was calculated as follows: (pVO2 × 2.194) + (PETCO2L × 1.545) + (LVEF × 1.134) + (HR × 1.055; 0 if AF, 1 if sinus rhythm). The score presented a high PP with an AUC of 0.866. A cut-off of 120 had an 83.6% sensitivity and a 75% specificity for MTV, and pts with a score value of &lt;120 had a markedly lower rate of MTV (log-rank p&lt;0.001). When compared to HFSS, our score presented a higher PP (0.866 vs 0.774, p=0.011).

Conclusion
A multivariable score based on readily available CPET Vs provides a simple, integrated and powerful method to predict HF events.

Funding Acknowledgement
Type of funding sources: None.
Can left ventricle mass index predict pacemaker-induced cardiomyopathy in patients with dual chamber permanent pacemakers implanted due to complete atrioventricular block?
Authors: Hayiroglu M , Cinar T , Cinier G , Yuksel G , Pay L , Keskin K , Coskun C , Ayan G , Cicek V , Tekkesin A I 
Published: October 2022

Abstract

Background
Pacing induced cardiomyopathy (PICM) occurs due to high-burden right ventricular pacing. In patients with complete atrioventricular (AV) block, it is presumed to have a higher burden of right ventricular pacing. There is a lack of data regarding the relationship between PICM and pre-implantation left ventricular mass index (LVMI).

Purpose
This study aims to investigate the effect of LVMI on PICM in patients with implanted dual chamber permanent pacemakers (PPM) due to complete AV block.

Methods
PPM implanted 577 patients were divided into three groups according to admission LVMI. Mean duration of follow-up was 57±38 months. The baseline characteristics, laboratory and echocardiographic variables were compared between the groups. The independent predictors of PICM incidence and the effect LVMI on PICM were evaluated.

Results
Age, post-implantation QRS duration, left atrium anteroposterior diameter and LVMI were determined to predict long-term PICM. After adjustment for confounding baseline variables, tertile with highest LVMI had 1.9 times higher rates of long-term PICM compared to tertile with lowest LVMI, which was used as the reference group. A ROC analysis showed that the optimal cut-off value of the LVMI to predict long-term PICM was 109.8 mg/m2 with 71% sensitivity and 62% specificity (AUC: 0.68; 95% CI: 0.60–0.76; p&lt;0.001),

Conclusion
Pre-implantation LVMI plays an important prognostic role in predicting PICM in patients with implanted dual chamber PPM due to complete AV block.

Funding Acknowledgement
Type of funding sources: None.
Global warming, renal function and heart failure: a 20-year follow-up study
Authors: Aimo A , Lupon J , Spitaleri G , Domingo M , Codina P , Santiago-Vacas E , Cediel G , Zamora E , Troya M I , Santesmases J , Romero-Gonzalez G A , Nunez J , Martini N , Emdin M , Bayes-Genis A 
Published: October 2022

Abstract

Background
There is a growing concern about the possible effects of global warming on human health. In HF outpatients, renal function significantly worsens during summer. More specific analyses on the impact of increasing temperatures on body homeostasis are lacking.

Purpose
We investigated the relationship between the trend of temperatures from 2002 to 2021 and renal function in heart failure (HF) outpatients.

Methods
All creatinine and estimated glomerular filtration rate (eGFR) values of HF outpatients followed at one tertiary hospital in a Mediterranean area of Spain were retrieved from electronic health records. eGFR was calculated through the CKD-EPI formula. Temperature data from the local municipality were derived from the Meteocat service; as temperatures from the years 2004–2005 were not available, these years were not analysed. Summer was defined as the timespan from June to September included. We calculated average values of creatinine and eGFR during summer and the rest of the same year, considering each patient and each year. Similarly, we averaged temperature values during summer and the rest of the same year.

Results
We derived 6,307 couples of average creatinine/eGFR values in summer and in the rest of the year from 2,194 patients. Across all the years (2002–2003 and 2006–2021), creatinine was slightly higher in summer than in the rest of the year (1.26 vs. 1.21 mg/dL, p&lt;0.001), and eGFR was lower (65 vs. 67 mL/min/1.73 m2, p&lt;0.001). Temperatures in summer and the rest of the year increased gradually, albeit not linearly, from 2002 to 2021 (Figure 1). The absolute (Δ) and percent changes (Δ%) in median temperatures between summer and the rest of the year increased across years (r=0.149, p=0.001 and r=0.144, p=0.002, respectively), as well as Δ and Δ% of the monthly median of maximal temperatures (r=0.119, p&lt;0.001 and r=0.052, p&lt;0.001, respectively) (Figure 1). The Δ and Δ% temperatures between summer and the rest of the year displayed several significant correlations with Δ and Δ% creatinine and eGFR after adjusting for several variables including age, sex, HF therapies, and creatinine outside of summer (Figure 2).

Conclusions
Over a 20-year timespan there has been an increase in 1) temperatures in summer and in the rest of the year, and 2) the temperature excursion between summer and the rest of the year. Changes in temperatures between summer and the rest of the year correlated with the magnitude of the decrease in renal function during summer, likely because of worse dehydration with higher temperatures. Therefore, the progressive rise in temperature may have detrimental effects on renal function during summer in HF outpatients.

Funding Acknowledgement
Type of funding sources: None.
Factors predicting diuretic resistance in patients with acute decompensated heart failure
Authors: Pratama A P , Hersunarti N , Soerarso R , Zahara R , Kurniawati Y , Hasanah D Y , Sukmawan R 
Published: October 2022

Abstract

Background
Heart failure is a leading cause of hospitalisation and mortality with high incidence and ever-increasing prevalence in the world. Although novel methods in management of acute decompensated heart failure (ADHF) have been developed, mortality and rehospitalisation rates remain high. Loop diuretics have been shown to be effective in relieving congestion and have been recommended in many heart failure guidelines. Continuous use of loop diuretics may cause complications in the form of diuretics resistance. The prevalence of diuretic resistance ranges from 20–35% in the heart failure population and has been shown to be a predictor of mortality and an increased incidence of hospitalisation. Until now there are debates in determining the clinical indicators of diuretic resistance. However, the clinical characteristics of patients with acute decompensated heart failure that predict the development of diuretic resistance have not been widely studied and previous studies have shown different results from one another.

Purpose
This study aims to identify factors that influence the occurrence of diuretic resistance in ADHF patients based on clinical profiles, medical histories, and laboratory findings.

Methods
This was a retrospective cohort study on patients treated due to ADHF from January-December 2019. Diuretic resistance was defined as a diuresis response less than 1400 ml in the first 24 hours after administration of 40 mg of intravenous furosemide.

Results
Data from 535 patients were analysed. The prevalence of diuretic resistance in this study was 68%. Independent predictors obtained from multivariate logistic regression analysis were Type II Diabetes Mellitus (p=0.013), history of prior iv loop diuretics &gt;6 days (p=0.002), history of oral loop diuretic dose &gt;80 mg/day (p=0.006), LVEF ≤49% (p=0.002), BUN ≥21 mg/dL (p&lt;0.001) and serum chloride &lt;98 mmol/L (p&lt;0.001). In addition, a scoring system has been generated from the final model with AUC 0.749.

Conclusions
Independent predictors for diuretic resistance obtained from this study were DM, history of prior iv loop diuretics &gt;6 days, history of oral loop diuretic dose &gt;80 mg/day, LVEF ≤49%, BUN ≥21 mg/dL and serum chloride &lt;98 mmol/L.

Funding Acknowledgement
Type of funding sources: None.
Factors associated with health-related quality of life in heart failure in 23,000 patients from 40 countries: results of the global congestive heart failure research program
Authors: Johansson I , Balasubramanian K , Bangdiwala S , Mielniczuk L , Hage C , Sharma S K , Branch K , Yonga G , Kragholm K , Sliwa K , Roy A , Stork S , McMurray J J V , Conen D , Yusuf S 
Published: October 2022

Abstract

Background
Poor health-related quality of life (HRQL) is common in heart failure (HF) and strongly predicts death and HF hospitalization in all regions of the world. Understanding facors associated with HRQL could therefore lead to improved prognosis in HF patients. Despite that the majority of HF occurs in low- and middle-income countries, there are limited data characterizing self-perceived health HRQL and its correlates in these settings.

Purpose
To examine clinical and social correlates of HRQL in patients with HF from high- (HIC), upper middle- (UMIC), lower middle-(LMIC) and low-income (LIC) countries.

Methods
Between 2017 and 2020, we enrolled 23,292 patients with HF (32% inpatients, 61% men) from 40 countries in the Global Congestive Heart Failure Study. We recorded HRQL at baseline using Kansas City Cardiomyopathy Questionnaire (KCCQ)-12. In a cross-sectional analysis, we compared age- and sex-adjusted mean KCCQ-12 summary scores (SS: 0–100, higher=better) between patients from different country income levels. We used multivariable linear regression examining correlations (estimates expressed as β-coefficients) of KCCQ-12-SS with sociodemographic-, comorbidity-, treatment- and symptom-covariates. The adjusted model (37 covariates) was informed by univariable findings, clinical importance and backward selection. We used partial R2-estimates to understand the contribution to the variability in KCCQ-12-SS of 4 different groups of covariates. (sociodemographic, comorbidities, treatments and signs and symptoms of congestion).

Results
Mean age was 63 years and 40% were in NYHA class III–IV. Average HRQL was 55± SD 0.5. It was 62.5 (95% CI 62.0–63.1) in HIC, 56.8 (56.1–57.4) in UMIC, 48.6 (48.0–49.3) in LMIC, and 38.5 (37.3–39.7) in LICs (p&lt;0.0001). Strong correlates (β-coefficient [95% CI]) of KCCQ-12-SS were NYHA class III vs class I/II (−12.1 [−12.8 to −11.4] and class IV vs. class I/II (−16.5 [−17.7 to −15.3]), effort dyspnea (−9.5 [−10.2 to −8.8]) and living in LIC vs. HIC (−5.8 [−7.1 to −4.4]). Symptoms explained most of the KCCQ-12-SS variability (partial R2=0.32 of total adjusted R2=0.51), followed by sociodemographic factors (R2=0.12). Results were consistent in populations across income levels.

Conclusion
The most important correlates of HRQL in HF patients relate to HF symptom severity, irrespective of country-income level. Improved symptom control may have a big impact on HRQL, especially in LICs.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Bayer AG