bluuebunny/crossref_metadata_2025_split huggingface dataset:
Looking beyond left ventricular ejection fraction – a new multiparametric CMR score to refine the prognostic assessment of HF patients
Authors: Lopes Da Cunha G J , Rocha B , Sousa J , Maltes S , Brizido C , Strong C , Guerreiro S , Abecasis J , Andrade M J , Aguiar C , Saraiva C , Freitas P , Mendes M , Ferreira A 
Published: October 2022

Abstract

Background
Cardiac magnetic resonance (CMR) is recommended in Heart Failure (HF) to assess myocardial structure and function. Recently, the quantification of pulmonary congestion and skeletal muscle mass using CMR have been shown to predict adverse events in HF, but a tool integrating this information is currently unavailable. The purpose of this study was to develop and test a new multiparametric CMR-derived score.

Methods
We conducted a single-center retrospective study of consecutive HF patients with left ventricular ejection fraction (LVEF) &lt;50% who underwent CMR. Several CMR parameters with known prognostic value were assessed, including: LVEF, Lung Water Density (LWD), Pectoralis Major Muscle (PMM) area, and presence of Late Gadolinium Enhancement. PMM area was outlined at the level of the carina – Figure 1A, B – and LWD was defined as the lung-to-liver signal ratio multiplied by 0.7, as previously described. Both parameters were measured in standard HASTE images - Figure 1C. The primary endpoint was a composite of all-cause death or HF hospitalization. Using the Cox regression Hazard Ratios of designated variables, a risk score was developed.

Results
Overall, 436 patients were included. During a median follow-up of 27 (17–37) months, 43 (9.9%) patients died and 57 (13.2%) had at least one hospitalization for HF. LVEF, LWD and PMM were independent predictors of the primary endpoint and were included in the CMR-HF score – Figure 2. The annual rate of events increased from 4.7 to 7.5 and 20.0% from lowest to highest tertile of the score. Roughly half of the events (54%) occurred in patients in the highest tertile of the CMR-HF score. In multivariate analysis, the new score independently predicted the primary endpoint (HR per 5 points: 1.54; 95% CI: 1.21–1.97; p&lt;0.001) even after adjustment for age, body mass index, NYHA class, NT-proBNP, estimated glomerular filtration rate, presence of implantable cardioverter-defibrillator, and ischemic etiology.

Conclusions
This novel multidimensional CMR-HF score, combining easily obtainable data on left ventricular pump failure, lung congestion and muscular wasting, is a promising tool identifying HF patients with an LVEF &lt;50% at higher risk of death or HF hospitalization.

Funding Acknowledgement
Type of funding sources: None.
Sudden cardiac death in heart failure. A 20 years perspective from a Mediterranean cohort
Authors: Codina Verdaguer P , Zamora E , Levy W C , Domingo M , Santiago-Vacas E , Cediel G , Santesmases J , Ruiz-Cueto M , Diez-Quevedo C , Roig T , Troya M I , Casquete D , Sarrias A , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Although sudden cardiac death (SCD) has progressively decreased in the last decade, it remains an important cause of death in patients with heart failure (HF). Differences based on clinical management and regional characteristics might be important.

Purpose
To assess the prevalence of SCD along 20 years of study in HF outpatients of different aetiologies managed in a multidisciplinary HF Clinic, and compare this prevalence with the expected proportional occurrence according to the acknowledged Seattle Proportional Risk Model (SPRM) score.

Methods
In a prospective observational registry of real-life HF outpatients, modes of death were classified as SCD (any unexpected death, witnessed or not, of a previously stable patient with no evidence of worsening HF or any other known cause of death) and non-SCD (progression of HF, acute myocardial infarction, stroke, procedural, other cardiovascular causes and non-cardiovascular).

Results
From August 2001 to May 2021, 2772 outpatients with known cause of death and with SPRM score available were included. Out of them, 1351 (48.7%) died during a median follow-up of 3.8 years [IQR 1.6–7.8], up to 20 years. Observed prevalence of SCD in the 1351 dead patients was 13.6% while predicted SPRM prevalence was 39.6%. Annual SPRM predicted SCD mortality rate was 3.0% while observed SCD annual mortality rate was 1.3%. Figure 1 depicts cumulative incidence of causes of death through the study period. A lower prevalence of SCD was observed in every quintile of SPRM risk (Figure 2). This lower prevalence of SCD was observed independently of left ventricular ejection fraction group, ischemic or non-ischaemic aetiology and implantable cardiac defibrillator (ICD). Although the baseline SPRM predicted risk of SCD showed a significant decreasing trend (p=0.005) along the periods of admission at the Unit, the lower observed prevalence of SCD was seen in all periods of admission.

Conclusions
The prevalence of SCD through a perspective of 20 years in a Mediterranean HF outpatient cohort managed in a multidisciplinary HF Clinic was significantly lower than that expected according to the SPRM independently of degree of predicted risk, ischaemic aetiology, period of admission and implanted ICD. Regional lifestyle and dietary habits may have an impact on the lower rate of SCD in this Mediterranean cohort, and deserve further in-depth analyses.

Funding Acknowledgement
Type of funding sources: None.
Mortality and predictors of death in women and men with congestive heart failure of different types of cardiomyopathies
Authors: Mansur A D P , Del Carlo C H , Ramos Neto J A , Abreu A B , Scipioni A R , Pereira-Barreto A C 
Published: October 2022

Abstract

Background
Congestive heart failure (CHF) is one of the leading causes of death from cardiovascular disease and years lived with disability. Studies showed that women had better survival than men despite higher hospitalizations in women. However, there is evidence of a gender-associated risk of dying of heart failure of different types of cardiomyopathies (CMP).

Purpose
To analyze the mortality of CHF due to different types of CMP in women and men

Methods
From February 2017 to September 2020, we analyzed the mortality and the predictors of death in women and men with CHF (Framingham criteria) in five types of CMP (ischemic, idiopathic, hypertensive, Chagas, and valve disease). Baseline data included clinical characteristics and echocardiographic findings. Statistical analyses used the Kaplan-Meier (K-M) method and the Cox proportional hazards methods to analyze death rates and search for predictors of death for women and men for each CMP.

Results
We studied 12,015 patients, mean of 63.8±14.3 years, 6637 (55%) males. For all patients, death occurred in 27.5%, 15.3%, 17.5%, 40.1%, and 24.4%, respectively, for ischemic, idiopathic, hypertensive, Chagas, and valve CMPs (p&lt;0.0001). HFrEF was more prevalent in idiopathic (51.2%) and Chagas (49.9%), and for HFpEF valve disease (80.4%), hypertensive (51.9%), and ischemic (44.4%). Compared to men, women were older, had a higher baseline mean left ventricular ejection fraction (LVEF), and a lower left ventricular diastolic diameter (LVDD) for all five types of CMP (p&lt;0,001). Over a 3-years follow-up period, the cumulative incidence of death was higher in men with ischemic CMP (38% vs. 31%; p=0.037) and Chagas CMP (48% vs. 38%; p&lt;0,001) but similar for idiopathic, hypertensive, and valve disease CMP (figure). Cox regression analysis for death, for each CMP, adjusted for confounders such as age, sex, previous myocardial infarction, diabetes, previous stroke, chronic kidney disease (CKD), atrial fibrillation (AF), any cardiac surgery, cardiac pacemakers, and LVEF showed that men were an independent predictor of death only for Chagas CMP (HR=1,28; 95% CI: 1.08–1.43; p=0.009).

Conclusion
Men were at a higher risk of death in ischemic and Chagas CMP but not for idiopathic, hypertensive, and valve CMP. The other main predictors of death were similar for all types of CMP, namely CKD, stroke, diabetes, and AF.

Funding Acknowledgement
Type of funding sources: None.
Legacy effects of infection in patients with heart failure: a national cohort study of 31,318 patients in Taiwan
Authors: Chen C Y , Li Y H , Lee C H , Lin H W , Lin S H 
Published: October 2022

Abstract

Background
Although infection is a common cause of hospitalization in patients (pts) with heart failure (HF), the long-term cardiovascular (CV) prognosis in HF after infection is not well studied.

Methods and results
From 2009 to 2015, 310,485 pts with their first HF admissions and survival to discharge were identified from the National Health Insurance Research Database. Among the pts, 103,505 (33.3%) were readmitted within 1 year after HF discharge for infection, including pneumonia (44.2%), urinary tract infection (UTI) (37.9%), skin and soft tissue infections (9.7%), and others (8.1%). Those without admission for any infection were controls. We compared the primary composite endpoint, including all-cause death, acute myocardial infarction (AMI), stroke, and hospitalization for HF (HHF) between the 2 groups after the infection episode. After propensity score matching, the clinical characteristics (age 71.7±13.9 years, male 52.0%) and treatment were similar between the groups (n=15,659 in each group). In a mean follow-up time of 4.3±2.9 years, 86.2% pts with a history of infection admission and 63.6% pts in the control group met the primary endpoint. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of the primary composite endpoint (HR 1.760, 95% CI 1.714–1.807), including all-cause death (HR 1.587, 95% CI: 1.540–1.636), HHF (HR 1.993, 95% CI 1.922–2.066), AMI (HR 1.332, 95% CI 1.224–1.450), and stroke (HR 1.769, 95% CI 1.664–1.882). In infection group, HHF was the earliest outcome event with a mean time of 17.5 months and mortality is the second early event with a mean time of 23 months after discharge from the infection episode. Pneumonia carried a higher risk than UTI for the primary composite endpoint (HR 1.140, 95% CI 1.104–1.178).

Conclusions
One-third of HF pts discharged from the hospital experienced acute infection that required readmission. The pts had worse CV prognosis after readmission for infectious disease compared to those without infection

Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This study is supported by National Cheng Kung University Hospital and Tainan Hospital, Ministry of Health and Welfare, Taiwan.
Heart failure admission to a cardiology department versus other internal medicine department is associated with improved long-term survival
Authors: Myhre P , Odegaard K M , Ravn J , Schirmer H 
Published: October 2022

Abstract

Background
Hospitalization for heart failure (HF) is associated with a high risk of in-hospital mortality, but also poor long-term outcomes. Although most hospital systems aim to admit patients with HF to cardiology departments, a significant proportion is admitted to other internal medicine departments due to shortages of beds and limited resources. The prognostic importance of being admitted to different departments is unknown.

Purpose
To compare the long-term mortality rate in patients admitted to hospital with a first diagnosis for HF to a cardiology department versus other internal medicine departments at a large academic hospital in Norway with a catchment area of 560,000 individuals.

Methods
Adult patients with a first ICD-10 diagnosis of HF (I11.0, I13.0, I13.2, I42.x, I50.x) admitted to an internal medicine department at our University Hospital between 2011 and 2019 were included. All-cause mortality was obtained from the Norwegian Cause of death registry until December 31, 2021.

Results
In total, we included 7,692 patients aged 76.1±13.0 years, of whom 46.0% were women, 57.4% had hypertension, 24.1% diabetes, 47.0% established coronary artery disease (CAD) and 36.0% a previous acute myocardial infarction (AMI). Of these, 50.7% were admitted to the cardiology department, 13.5% to the pulmonary department, 7.6% to the infectious disease department and the rest to other internal medicine departments. Patients admitted to the cardiology department were younger and more frequently men with established heart disease. They were more frequently examined with echocardiography during the first 30 days after admission, but had comparable levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) to those admitted to other departments (Table 1). During mean 5.9 years of follow-up, 56.6% of patients died. Patients admitted to the cardiology department had 37% lower mortality risk compared to other departments (HR 0.63 [95% CI 0.59–0.66], p&lt;0.001). This association persisted after adjusting for age, sex, comorbidities (listed in the Table), NT-proBNP and undergoing echocardiographic examination (HR 0.75 [0.70–0.80], p&lt;0.001). Having an echocardiographic examination was also associated with lower mortality risk in the same multivariable model (HR 0.92 [95% CI 0.86–0.97], p&lt;0.001).

Conclusion
Admission to a cardiology department with HF is associated with better long-term outcomes compared to admission to other internal medicine departments. These findings support health care policy efforts to expand capacity at cardiology departments to allow best care for these vulnerable patients.

Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): This study was in part funded by research grants from Novartis.
Aortic valve calcium in relation to subclinical cardiac dysfunction and risk of heart failure in the general population
Authors: Zhu F , Kaiser Y , Boersma H , Bos D , Kavousi M 
Published: October 2022

Abstract

Background
Emerging evidence suggests that aortic valve calcium (AVC) is associated with adverse cardiovascular outcomes, while the association of (early) AVC with subclinical cardiac dysfunction and with risk of heart failure (HF) remains unclear.

Purpose
To determine the association of CT-assessed AVC with echocardiographic measurements of cardiac dysfunction, and with HF in the general population.

Methods
We included 2,348 participants (mean age 68.5 years, 52% women) of the Rotterdam Study, who had AVC measured between 2003 and 2006, and without a history of HF at baseline. Linear regression models were used to explore cross-sectional associations of AVC with echocardiographic measures at baseline. All participants were followed for HF event until December 2016. Cox proportional hazard models were used to assess the association of AVC with incident HF. Models were adjusted for potential confounders.

Results
The presence of AVC was associated with 3.14 g/m2 (95% CI, 1.50 to 4.79) higher mean left ventricular mass indexed by body surface area. One-unit larger log (AVC+1) was associated with 0.01 mm (95% CI 0.01 to 0.02) larger mean left atrial size. During a median follow-up of 9.8 years, 182 incident HF cases were identified. Presence of AVC was associated with 37% greater risk for HF (HR, 1.37; 95% CI, 1.01 to 1.87). One-unit larger log (AVC+1) was associated with 11% larger risk of HF (HR, 1.11; 95% CI, 1.04 to 1.18). Compared with the AVC =0, AVC ≥100 had 1.70 folded risk of HF (HR, 1.70; 95% CI, 1.17 to 2.49).

Conclusions
The levels of AVC were associated with markers of left ventricular structure and with risk of HF, independent of traditional cardiovascular risk factors. Larger CT-assessed AVC is an indicative of increased risk for development of HF.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Netherlands Organization for the Health Research and Development (ZonMw)Dutch Heart Foundation (03-004-2021-T050)
Developing and validating a prognostic model for mortality in patients with heart failure
Authors: Muhammad-Kamal H , Iyen B , Weng S 
Published: October 2022

Abstract

Background
Heart Failure (HF) constitutes a major public health problem which remains highly prevalent in the UK and globally. Primary care plays a role in the long-term management of patients with heart failure but there are no clinically useful prognostic models to guide primary care professionals in determining those at increased risk of mortality, who could benefit from appropriate advanced care planning or escalation of treatment. Several predictive models exist but due to several limitations, clinical utility of these in the UK are limited.

Purpose
This study developed and validated a prognostic algorithm, the Nottingham Heart Failure Model, to predict the one-year risk of all-cause mortality in patients with HF.

Methods
This was a retrospective open cohort study using electronic primary care records from the UK Clinical Practice Research Datalink (CPRD) linked with secondary care records from Hospital Episode Statistics (HES) and death registration data from the Office for National Statistics (ONS). Adults with a diagnosis of heart failure were identified and multivariable Cox regression models were used to identify the risk factors that were independently associated with mortality. A prognostic model was developed to predict the one-year risk of mortality in patients with heart failure, and this was validated by bootstrapping 200 samples of the derivation data. The cohort was then split into even quartiles based on predicted risk scores from the model. These risk groups ranged from one to four with one indicating the quartile of scores with the lowest risk. Kaplan Meier curves were then produced for each group. The Royston D-statistic was then used to assess the discrimination of these quartiles by quantifying the observed separation between these groups.

Results
A total of 109,577 patients with diagnoses of heart failure were followed up from 1 January 2000 to 31 December. There were 16,437 deaths during the period of follow up. We identified 29 factors which were significantly associated with mortality risk and a prognostic model which incorporated these factors, was developed. The resulting prognostic model obtained a model validation score (C-statistic) of 0.79. The agreement between the observed and predicted proportion of events showed excellent apparent calibration. The D statistic of 1.65 suggests that the model provides a reasonably high amount of prognostic separation.

Conclusion(s)
Several patient characteristics including comorbidities, treatments, and biomarkers are significantly associated with heart failure mortality. This new model has the potential to accurately predict heart failure mortality within one year and will enable primary care professionals to better risk stratify their patients with heart failure.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): The Aziz Foundation
Plasma amyloid-beta in relation to cardiac function and risk of heart failure in the general population
Authors: Zhu F , Wolters F J , Yaqub A , Boersma H , Ikram M A , Kavousi M 
Published: October 2022

Abstract

Background
Amyloid-β is a major hallmark of Alzheimer's disease, and its pathology has been hypothesized as a multiple organ syndrome that may also affect cardiac function. There are limited data on association of plasma amyloid-β with cardiac dysfunction and risk of HF in the general population.

Objective
To determine the association of plasma amyloid-β40 (Aβ40) and amyloid-β42 (Aβ42) with echocardiographic measurements of cardiac dysfunction, and with incident heart failure (HF) in the general population.

Methods
We included 4156 participants of the population-based cohort (mean age 71.4 years, 57.1% women), who had plasma amyloid-β measured between 2002 and 2005, and were free of dementia and HF at baseline. Multivariable linear regression models were used to explore the associations of plasma Aβ40 and Aβ42 with echocardiographic measures. Participants were followed for the occurrence of HF until December 2016. Cause-specific hazard models were used to assess the association of plasma amyloid-β with incident HF and competing risk event. Models were adjusted for cardiovascular risk factors.

Results
Higher plasma Aβ40 concentrations were associated with lower left ventricular ejection fraction (β, −0.39; 95% CI, −0.68 to −0.10) and larger left ventricular mass (β, 0.70; 95% CI, 0.06 to 1.34). Aβ42 was not significantly associated with echocardiographic measures cross-sectionally. During follow-up (median 10.2 years), 472 incident HF cases were identified. Higher plasma Aβ40 was associated with an increased risk of incident HF (HR, 1.32; 95% CI, 1.15 to 1.51), more profound in men than in women (P value for interaction: 0.022). One SD increase in Aβ40 was associated with a 31% increase in the hazard of HF in men (HR, 1.32; 95% CI, 1.14 to 1.54) but the association was not significant in women (HR, 1.06; 95% CI, 0.93 to 1.20). Higher plasma Aβ42 concentrations were associated with increased risk of HF (HR, 1.12; 95% CI, 1.02 to 1.24), while further adjustment for concomitant Aβ40 attenuated this association (HR, 1.03; 95% CI, 0.92 to 1.16).

Conclusion
Higher levels of plasma Aβ40 were independently associated with worse cardiac function and higher risk of new-onset HF in the general population, in particular among men.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): The Netherlands Organization for Health Research and Development (ZonMw); the Dutch Heart Foundation;This study is further funded by the European Union's Horizon 2020 research and innovation programme as part of the Common mechanisms and pathways in Stroke and Alzheimer's disease (CoSTREAM) project.
Hypertension is associated with more advanced heart failure in african americans with suspected cardiac amyloidosis
Authors: Manjunath S , Deych E , Lenihan D J , Zhang K W 
Published: October 2022

Abstract

Background
Prior studies have shown worse clinical outcomes for African Americans with transthyretin and light chain cardiac amyloidosis as compared to Caucasians. Hypertensive heart disease is common among African Americans, and a known echocardiographic mimic of cardiac amyloidosis. The association between hypertension and heart failure severity in patients with suspected cardiac amyloidosis has not been well characterized.

Purpose
We sought to identify phenotypic differences between African American and Caucasian patients with suspected cardiac amyloidosis with and without hypertension.

Methods
We retrospectively identified consecutive patients who underwent cardiac biopsy for evaluation of cardiac amyloidosis at our institution between 2000–2018. Clinical and demographic data were obtained from the medical record. Electrocardiograms and echocardiograms performed at the time of cardiac biopsy were interpreted by study personnel.

Results
Among 230 patients with suspected cardiac amyloidosis, 144 (58%) had a prior diagnosis of hypertension. Hypertension was more common among African Americans (71 of 91, 78%) than among Caucasians (73 of 139, 52%). Among African Americans with suspected cardiac amyloidosis, those with hypertension had higher left ventricular mass index (156 versus 119 g/m2), lower left ventricular ejection fraction (47% versus 56%), worse global longitudinal strain (−9.0% versus −11.7%), and higher creatine (1.95 versus 1.43 mg/dL) than those without hypertension (p&lt;0.05 for all). There were no differences in these parameters among Caucasians with and without hypertension.

Conclusions
Among African Americans with suspected cardiac amyloidosis, those with hypertension had worse systolic function and more advanced heart failure than those without hypertension. Targeted screening and/or surveillance strategies are needed to improve early diagnosis of cardiac amyloidosis in African American patients with hypertension.

Funding Acknowledgement
Type of funding sources: None.