bluuebunny/crossref_metadata_2025_split huggingface dataset:
Factors of persistent limited exercise tolerance in patients after COVID-19 with normal left ventricular ejection fraction
Authors: Gryglewska K , Sakowicz A , Banach M , Maciejewski M , Bielecka-Dabrowa A 
Published: October 2022

Abstract

Background
Exercise intolerance de novo is one of the most common reported symptoms in patients (pts) recovering from COVID-19.

Purpose
The present study determines etiological and pathophysiological factors influencing the mechanism of exercise intolerance in the COVID-19 survivors. Therefore, the factors affecting percent predicted oxygen uptake at peak exercise VO2 (%VO2pred) in pts after COVID-19 with normal left ventricular ejection fraction were assessed.

Methods and results
The 120 consecutive patients from the Department of Cardiology recovering from COVID-19 at three to six months after confirmed diagnosis were included. The clinical examinations, laboratory test results, echocardiography using Vivid E95 – GE Healthcare, non-invasive body mass analysis using Body Composition Analyzer (Tanita Pro), and spiroergometry using The MetaSoft® Studio application were analysed. The subjects were divided into the two following groups: study i.e. pts with worse oxygen uptake (%VO2pred &lt;80%; N=47) and control including these cases with %VO2pred ≥80% (N=73) – Table 1. Pts with %VO2pred &lt;80% presented significantly lower global peak systolic strain (GLPS) [p=0.03], tricuspid annular plane systolic excursion (TAPSE) [p=0.002] and late diastolic filling velocity (A) [p=0.004] compared to controls – Figure 1. The male gender (p=0.007) and the percent of total body water content (TBW %) (p=0.02) were significantly higher in study in comparison to the control group. The results of multiple logistic regression model independently associated with %VO2pred were as follows: A (OR 0.4, 95% CI: 0.17–0.95; p=0.03) and gender (OR 2.52, 95% CI: 1.07–5.91; p=0.03).

Conclusions
Males have over twice risk of persistent limited exercise tolerance after COVID-19 infection than females. The lower late diastolic filling velocity, tricuspid annular plane systolic excursion, worse global peak systolic strain, and hydration status are connected with limited exercise tolerance after COVID-19 in patients with normal left ventricular ejection fraction.

Funding Acknowledgement
Type of funding sources: None.
Profile and prognosis of patients with heart failure with recovered ejection fraction
Authors: Rocamora-Horrach M , Peiro O , Serrano I , Rodriguez J , Carrasquer A , Ferrero-Guillem M , Romeu A , Lal-Trehan N , Sanchez R , Del Moral V , Delgado J R , Bardaji A 
Published: October 2022

Abstract

Background
Patients with heart failure (HF) and reduced ejection fraction (rEF) have a poor prognosis. Nevertheless, in the subgroup of patients with recovered ejection fraction (recEF) prognosis is unknown.

Purpose
To analyze characteristics and prognosis in patients with HFrEF (initial EF and at one year &lt;40%) and HFrecEF (initial EF &lt;40% and at one year ≥40% with ≥10% absolute improvement from the initial value).

Methods
Retrospective observational study of outpatients referred to the HF unit within March/2006 and November/2021. Baseline characteristics, ecocardiographic data and follow-up were collected, discerning between patients with HFrEF and HFrecEF.

Results
A total of 346 patients (76.0% men) were analyzed with a mean of age 66.3 (IQR 57.8–74.4) years, of which 50.6% remained with rEF and 49.4% recEF. Median follow-up was 4.6 (2.8–7.9) years. Both groups had a similar risk profile albeit less prevalence of dyslipidemia in the group with recEF (43.5% vs 56.7%, p=0.015). Ischemic etiology predominated in those with rEF (41.7% vs 25.7%, p=0.002) and enolic in recEF (10.5% vs 3.4%, p=0.009). The incidence of combined event (readmission for HF or death) was lower in HFrecEF (33.6% vs 66.4%, p&lt;0.001), as well as death (33.9% vs 66.1%, p&lt;0.001) and readmission for HF (24.4% vs 75.6%, p&lt;0.001). Prevalence of cardiovascular death was lower in the group with recEF (37.8% vs 61.1%, p=0.021). In the multivariate analysis, rEF was an independent predictor for the combined event (HR 2.17; 95% IC [1.45–3.25], p&lt;0.001), as well as for global mortality and readmission for HF.

Conclusion
Patients with HFrecEF have a similar risk profile than patients with HFrEF although with better long-term prognosis.

Funding Acknowledgement
Type of funding sources: None.
History of heart failure and chronic kidney disease and the risk for all-cause death after COVID-19 during the three first waves in comparison to influenza outbreaks in Sweden
Authors: Ritsinger V , Bodegard J , Kristofi R , Thuresson M , Nathanson D , Nystrom T , Eriksson J W , Norhammar A 
Published: October 2022

Abstract

Background
Infection with SARS-CoV-2 (COVID-19) affects people globally causing hospitalisation and reduced life expectancy. To improve future preventive measures there is a need of extensive analysis on contributing risk factors for severe COVID-19 outcome.

Purpose
To explore how cardiorenal disease (CRD; heart failure and/or chronic kidney disease) impacted mortality in patients hospitalised for COVID-19 during the three first waves in Sweden in comparison to previous influenza outbreaks and with a sex perspective.

Methods
All patients in Sweden with a main hospital diagnosis of COVID-19 (January 2020-September 2021) or influenza (January 2015-December 2019) with previous CRD were identified in registries and compared with a reference group free from CRD but with COVID-19 or influenza. Associated risk of all-cause death during the first year was analysed using adjusted Cox proportional hazards models.

Results
In COVID-19 patients with and without prior history of CRD (n=44,866) mean age was 79.8 years (SD 11.8) and 43% were women. In influenza patients (n=8897) mean age was 80.6 (SD 11.5) years and 45% were women. COVID-19 vs. influenza was associated with higher mortality risk the first two waves (HR 1.53; 95% CI 1.45–1.62, p&lt;0.001 and 1.52; 1.44–1.61, p&lt;0.001) but not in the third wave (1.07; 0.99–1.14, p=0.072). The cumulative incidence of all-cause death was increased in COVID-19 patients and in influenza patients if CRD was present (Figure 1). Further, CRD was an independent risk factor for all-cause death after COVID-19 in men and women (men: 1.37; 1.31–1.44, p&lt;0.001, women: 1.46; 1.38–1.54, p&lt;0.001). At ages &lt;70 years women with CRD had a similar mortality rate as men with CRD while at ages ≥70 years mortality rate was higher in men (Figure 2).

Conclusions
Outcome after COVID-19 is worse if CRD is present. In women at ages &lt;70 years the presence of CRD attenuates the protective effect of female sex. Further COVID-19 was associated with higher mortality risk than influenza during the first two waves.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): The Family Kamprad FoundationAstraZeneca (study sponsor)
Prediction of mortality and mode of death in heart failure using multimorbidity and clinical risk score systems: a nationwide analysis
Authors: Fauchier L , Bodin A , Bentounes S A , Bisson A , Herbert J , Genet T , Ivanes F , Angoulvant D 
Published: October 2022

Abstract

Heart failure (HF) is associated with a higher mortality, but modes of death may vary and their respective predictors have been insufficiently defined. Charlson comorbidity index (CCI) is a tool to quantify multimorbidity and a strong estimator of mortality. The quantifiable frailty phenotype is also predictive of mortality and disability and claims data can be used to classify individuals as frail and non-frail using the Hospital Frailty Risk Score (HFRS). CHA2DS2-VASc score was originally employed as a risk assessment tool for stroke in patients with AF but this comprehensive risk assessment score may help identify HF patients who are at high risk for mortality. We evaluated whether these tools may help to predict mortality and the different modes of death in HF.

Methods
Based on the France nationwide administrative hospital-discharge database, the analysis focused on all patients with HF hospitalized in France in 2012, with at least 5 years of complete follow-up (or dead earlier) as described by others. We identified 371,848 consecutive patients hospitalized with HF seen in 2012 and followed until December 2019. Adverse outcomes were investigated during follow-up. CHA2DS2VASc score, CCI and HFRS were calculated for each patient.

Results
Among these 371,848 patients with HF, 220,774 patients died during a follow-up of 4.0±2.8 years (median 4.8) (yearly rate 14.8%, 31.3% cardiovascular and 68.6% non-cardiovascular deaths). Death occurred more often in patients with higher CHA2DS2VASc, CCI and HFRS scores. HFRS was a better predictor of total mortality than CCI and CHA2DS2VASc score (see C-statistics in Table 1). However, the CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and HFRS. By contrast, HFRS was a better predictor of non-cardiovascular mortality than CCI and CHA2DS2VASc score. The optimal predictive performances were better for non-cardiovascular death than for cardiovascular death.

Conclusion
Multimorbidity and frailty assessed with HFRS demonstrated better performances in predicting total mortality and non-cardiovascular mortality than CCI and CHA2DS2VASc score in HF patients. By contrast, CHA2DS2VASc score was a better predictor of cardiovascular mortality than CCI and HFRS in these patients.

Funding Acknowledgement
Type of funding sources: None.
CRT-D non-responders have worse cardiovascular outcome than patients after primary ICD implantation with similar baseline left ventricular ejection fraction
Authors: Toth A , Nagy L , Racz V , Szuromi L , Sandorfi G , Jenei C S , Szabo K , Csanadi Z 
Published: October 2022

Abstract

Background
Cardiac resynchronisation therapy (CRT) fails to improve echocardiographic parameters and outcome in 20–40% of heart failure (HF) patients with reduced ejection fraction (EF) referred to as CRT non-responders (CRT-NR). The aim of this study was to compare the outcomes of CRT-NR patients who received a CRT defibrillator (CRT-D) device with patients after primary implantable cardioverter-defibrillator (ICD) implantation for impaired left ventricular (LV) function.

Methods
CRT-NR status was defined as no or less than 10% improvement in LV EF 12 months post implantation. CRT-NR patients and those after primary ICD implantation for LV EF&lt;35% were identified in our database between 2010 and 2019. CRT-NR patients were further categorized as progressors (decrease in LV EF ≥5%) or non-progressors (LV EF change between +9 to −5%). Primary endpoint was all-cause mortality or the need for heart transplantation during follow-up. Statistical significance was assessed by Log-rank test of Kaplan-Meier survival analysis.

Results
151 CRT-NR patients and 219 patients after primary ICD implantation were identified with a mean ± SEM follow-up of 43.7±2.5 and 47.3±2.2 months, respectively. Baseline (preoperative) LV EFs were higher (p&lt;0.05) for the overall CRT-NR group (EF = 27.4±0.4%) than for the ICD group (EF = 25.2±0.3%) Further, both CRT-NR subgroups of progressors (n=49; EF = 28.6±0.7%) and non-progressors (n=102; EF = 26.9±0.5%) had also significantly higher baseline LV EF as compared to ICD patients (p&lt;0.05). No statistical significance was found between the two CRT-NR subgroups.
Event free median survival for the overall CRT-NR group (55.6 months) was significantly worse than for the ICD group (79.6; p&lt;0.05). This difference was driven by progressor patients who had a significantly worse event free survival (37.8 months, p&lt;0.05) than ICD patients, while vent free survival in non-progressors (60.8 months) was comparable to ICD patients (p=0.18).

Conclusion
Progressor subgroup of CRT-NR have worse outcome as compared to non-progressors and also to those after primary prevention ICD implantation. The poor prognosis of these patients should have implications for timely decision regarding all therapeutic measures currently available for the management of heart failure.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Project no. TKP2021-EGA-18 has been implemented with the support provided from the National Research, Developement and Innovation Fund of Hungary, financed under the TKP2021-EGA funding scheme
Temporal trends in first rehospitalisation for heart failure between 1997 and 2017. trends in hospitalization characteristics and prognostic impact
Authors: Arulmurugananthavadivel A A , Holt A H , Parveen S P , Lamberts M L , Gislason G H G , Torp-Pedersen C T P , Andersson C A , Butt J H B , Petrie M C P , McMurray J M , Fosbol E L F , Kober L K , Schou M S 
Published: October 2022

Abstract

Background
Neurohormonal blockade/modulation has improved life expectancy in HF, but it is unknown whether the time between a first hospitalisation for HF and the first rehospitalisation has increased.

Purpose
To investigate temporal trends of time between first hospitalisation for HF and first rehospitalisation for HF.

Methods
Using nationwide registers, 43,176 patients with a first hospitalization of HF during 1997–2017 were included. Temporal trends in a) time to first rehospitalisation for HF and b) mortality and rehospitalisation for HF after first rehospitalisation for HF were investigated, as was length of stay and inpatient mortality during first rehospitalisation. Rehospitalisation within 30 days was considered the same event as the index diagnosis.

Results
Between 1997 and 2017, the time between first hospitalisation for HF and first rehospitalisation increased from a median of 351 days to 464 days. During first rehospitalisation for HF, the median length of stay decreased from 6 days to 3 days, in-hospital death decreased from 10% to 6%, and the 90-day absolute risk of death after rehospitalisation decreased from 25% to 19% (Figure 1). After the first rehospitalisation for HF, the 1-year age-standardized mortality and HF rehospitalisation rates decreased, during 1997–2017, from 43 to 30/100-person and 35 to 25/100-person, respectively (Figure 2). Reductions in 5-year mortality and HF hospitalization were also observed. After discharge, an increasing number of patients were started on ACE-I or ARB (1997–2017: 73.7%–79.4%), beta-blockers (1997–2017: 33.7%–83.0%), and MRAs (1997–2017: 43.1%–49.7%) within 90 days after hospitalisation.

Conclusions
Between 1997 and 2017, the median time from first hospitalisation to first rehospitalisation for HF increased by 100 days, while the length of stay and in-hospital death during hospitalisation for HF decreased markedly. 1-year and 5-year mortality and HF rehospitalisation rates after first rehospitalisation for HF also decreased between 1997 and 2017.

Funding Acknowledgement
Type of funding sources: None.
Genetic analysis of Korean non-ischemic dilated cardiomyopathy using next generation sequencing
Authors: Oh J , Yoon M , Lee S H , Lee C J , Park S , Lee S H , Kang S M 
Published: October 2022

Abstract

Background
Non-ischemic dilated cardiomyopathy (NIDCM) is a genetic disorder that causes heart failure and life-threatening arrhythmia. However, there has been no study about the up-to-date genetic analysis for NIDCM in Korean. Therefore, we performed the genetic analysis of Korean NIDCM patients (pts) using next generation sequencing (NGS).

Methods
We analyzed clinical and echocardiographic data of 203 NIDCM in a single center from July 2017 to May 2020. All pts underwent NGS analysis with customized panel including 369 genes. Genetic variants were classified as pathogenic, likely pathogenic mutations or variants of uncertain significance regarding American College of Medical Genetics guideline.

Results
A total of 203 NIDCM pts (57±15 years old, 32.0% male, LVEF 28%) had NGS analysis. Thirty-seven (18.2%) pts had pathogenic or likely pathogenic mutations. The most prevalent mutated genes were TTN (n=16, 43.2%). TNNT2 (n=6, 16.2%), MYBPC3 (n=6, 16.2%) and MYH7 (n=3, 8.1%) mutated genes were common in the following order. The patients with positive panel mutation had no significant difference in initial LVEF (27% vs. 28%, p=0.216) and prevalence of atrial fibrillation (37.8% vs. 44.6%, p=0.454) compared with patients with negative panel mutation. During the median follow-up period of 40 months, there was no significant difference in composite outcome (all-cause death, heart transplantation, LVAD, heart failure re-admission, fatal arrhythmia) (35.3% vs. 32.2%, p=0.729) or presence of improved EF (≥10 points increase from baseline LVEF, and a second measurement of LVEF &gt;40%) (41.2% vs. 50.0%, p=0.354) between the two groups.

Conclusion
This is the first study of NGS analysis in Korean NIDCM pts. We could find disease-related pathogenic or likely pathogenic mutations in 18.2% NIDCM patients. Further prospective, large study should be warranted to elucidate the effect of genetic mutation in clinical manifestation and prognosis of NIDCM in Korean population.

Funding Acknowledgement
Type of funding sources: None.
The prognostic role of galectin-3 and endothelial function in patients with heart failure according to left ventricular ejection fraction classification HF group
Authors: Tsigkou V , Siasos G , Oikonomou E , Zaromitidou M , Mourouzis K , Dimitropoulos S , Bletsa E , Gouliopoulos N , Stampouloglou P K , Panoilia M E , Marinos G , Tsioufis K , Vavuranakis M , Tousoulis D 
Published: October 2022

Abstract

Background
Heart failure (HF) is nowadays classified in HF with reduced ejection fraction (HFrEF), HF with mildly-reduced EF (HFmrEF) and HF with preserved EF (HFpEF). Endothelial dysfunction, increased arterial stiffness and galectin-3, a biomarker of myocardial fibrosis, have been linked to major adverse cardiovascular events (MACE) in patients with ischemic HF.

Purpose
The purpose of this prospective, follow-up study was to investigate in patients with stable ischemic HF the prognostic role of circulating galectin-3 levels, endothelial function and arterial stiffness according to left ventricular ejection fraction classification.

Methods
In this study we prospectively enrolled 340 patients with stable ischemic HF. Patients were categorized in HFrEF (when EF below or equal to 40%), HFmrEF (when EF is more than 40%&lt;ef≤49%)&gt; and below/equal to 49%) and HFpEF (when EF is more/equal to 50% along with the presence of structural or functional dysfunction and/or elevated natriuretic peptides) according to recent guidelines upon 2D echocardiographic assessment. We evaluated flow-mediated dilatation (FMD) of brachial artery as a marker of endothelial function, carotid-femoral pulse-wave velocity (PWV) as a marker of arterial stiffness and galectin-3 levels as a biomarker of fibrosis. Patients were followed-up for MACE and the primary endpoint was defined as cardiovascular death, myocardial infarction, coronary revascularization, stroke, and hospitalization due to HF. &lt;ef≤49%)&gt;

Results
Interestingly, FMD values exhibited a stepwise improvement according to LVEF (HFrEF: 4.74±2.35% vs. HFmrEF: 4.97±2.81% vs. HFpEF: 5.94±3.46%, p=0.01) which remained statistically significant after the evaluation of possible confounders including age, sex, cardiovascular risk factors and number of significantly stenosed epicardial coronary arteries (b coefficient: 0.990, 95% CI: 0.166–1.814, p=0.019). Multivessel coronary artery disease (CAD) was more frequent in the group of HFrEF (HFrEF: 56% vs. HFmrEF: 64% vs. HFpEF: 73%, p=0.049). Nevertheless, PWV did not display any association with LVEF. Patients who presented MACE exhibited worse FMD values (4.51±2.35% vs. 5.32±2.67%, p=0.02) and the highest tertile of galectin-3 was linked to more MACEs (36% vs. 5.9%, p=0.01).

Conclusions
FMD values have a linear improvement according to LVEF increase in patients with ischemic HF and worse values are linked to more MACEs. Higher levels of galectin-3 might be used for risk stratification of patients with ischemic HF.

Funding Acknowledgement
Type of funding sources: None.
Prognostic value of estimating appendicular muscle mass in heart failure using creatinine/cystatin C
Authors: Sunayama T , Matsue Y , Dotare T , Maeda D , Yatsu S , Ishiwata S , Nakamura Y , Akama Y , Tsujimura Y , Suda S , Kato T , Hiki M , Kasai T , Minamino T 
Published: October 2022

Abstract

Objectives
As heart failure with concomitant sarcopenia has a poor prognosis, simple methods for evaluating the appendicular skeletal muscle mass index (ASMI) are required. Recently, a model incorporating anthropometric data and the sarcopenia index, that is, the ratio of serum creatinine to cystatin C (Cre/CysC), was developed to estimate the appendicular skeletal muscle mass. We hypothesized that this model would be superior to the previous model, which uses only anthropometric data to predict the prognosis. This study aimed to compare the prognostic value of low ASMI as defined by the biomarker and anthropometric models in patients with heart failure.

Methods
Among 847 patients, we estimated ASMI using an anthropometric model consisting of age, body weight, and height in 791 patients and a biomarker model that incorporates age, body weight, hemoglobin, and Cre/CysC in 562 patients. Patients were divided into low and non-low ASMI groups according to the ASMI estimated by each model, using the cut-off proposed by the Asian Working Group for Sarcopenia. The primary outcome was all-cause mortality.

Results
Overall, 53.4% and 39.1% of patients were diagnosed with low ASMI by anthropometric and biomarker models, respectively. The agreement of the diagnosis of low ASMI between the two models was poor, with a kappa coefficient of 0.56 (95% confidence interval: 0.49–0.63). Kaplan-Meier curves showed that a low ASMI was significantly associated with all-cause death in both models. However, this association was retained after adjustment for other covariates in the biomarker model (hazard ratio: 2.60, p=0.003), but not in the anthropometric model (hazard ratio: 0.70, p=0.257).

Conclusions and implications
Among patients hospitalized with heart failure, a low ASMI estimated using the biomarker model, but not the anthropometric model, was significantly associated with all-cause mortality.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development