bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prognostic value of brain natriuretic peptide in COVID-19 with or without acute heart failure
Authors: Bergami M , Manfrini O , Cenko E , Dorobantu M , Demiri I , Fronea O , Kedev S , Mjehovic P , Pasalic M , Poposka L , Stefanovic M , Vavlukis M , Milicic D , Zdravkovic M , Bugiardini R 
Published: October 2022

Abstract

Background
Although Brain Natriuretic Peptide (BNP) provides strong prognostic information of an unfavorable outcome in patients with acute heart failure (AHF), there is little information of its relevance as a biomarker for outcomes in COVID-19 and its complications

Purpose
To evaluate the association of increased BNP levels with complications and in-hospital mortality in a cohort of hospitalized COVID-19 patients.

Methods
The study included COVID-19 patients with data on BNP levels included in the ISACS COVID-19 registry. The population was categorized according to the presence of peak BNP levels ≥100 pg/mL during hospitalization. Primary outcomes included in-hospital mortality, AHF or acute respiratory failure (ARF, defined as PiO2/FiO2&lt;300 mmHg or need for mechanical ventilation). Calculations were conducted using age and sex-adjusted multivariable logistic regression analyses. Results were also stratified according to presence or absence of cardiovascular disease (CVD) history. Differences between subgroups were verified for statistical significance using test for interaction.

Results
Of the 1152 patients included in the study, 615 (53.4%) had elevated BNP levels. These subjects were older (69.9±13.8 vs 59.1±16.8, p-value&lt;0.001), had higher rates of cardiovascular risk factors (82.9% vs 57.7%, p-value&lt;0.001) and presented more frequently with a prior history of CVD (either ischemic heart disease, cerebrovascular disease, venous thromboembolism, atrial fibrillation or a history of revascularization) (50.1% vs 27.5%, p-value&lt;0.001). No sex differences were observed. When considering outcomes, BNP levels ≥100 pg/mL were associated with increased rates of in-hospital mortality (32.9% vs 4.9%, p-value&lt;0.001), even after adjustment for demographic characteristics (OR: 7.35; 95% CI: 4.75–11.40; p-value&lt;0.001). High BNP levels were also strongly associated with an increased risk of AHF (OR 19.9; 95% CI 8.6–45.9; p-value&lt;0.001), a correlation that persisted both in patients with and without a prior CVD history (p for interaction=0.29). Of note, patients with elevated BNP also had a higher likelihood of developing ARF (OR 2.7; 95% CI 2.1–3.6; p-value&lt;0.001), even in absence of AHF (OR 3.00; 95% CI 2.20–4.1; p-value&lt;0.001).

Conclusions
In COVID-19, blood BNP level not only appears to be predictor of in-hospital mortality and AHF but was also independently associated with an increased risk of ARF. This finding supports the routine use of BNP in all patients admitted to hospital for COVID-19, regardless of a prior history of CVD.

Funding Acknowledgement
Type of funding sources: None.
Echocardiographic diversity associated with exercise capacity in heart failure precursor stage B: the Project Baseline Health Study
Authors: Cauwenberghs N , Daubert M A , Salerno M , Haddad F , Kuznetsova T , Douglas P S 
Published: October 2022

Abstract

Background
The current paradigm to stage heart failure (HF) defines precursor stage B (or “pre-HF”) as having any subclinical change in cardiac structure or function. Yet, HF risk factors and type of cardiac abnormality may induce clinically relevant heterogeneity in HF stage B. Therefore, we assessed clinical and echocardiographic heterogeneity within stage B HF and its association with exercise capacity in a large community-based sample.

Methods
2071 participants to the Baseline Health Study (50.4±17.0 years, 56.2% women, 37.8% hypertensive) underwent echocardiography and physical performance testing including 6-minute walk (6MWT) and treadmill exercise test. We defined echocardiographic profiles of left and right heart remodeling and dysfunction using sex-specific internal reference values. We assessed HF stages (0-A-B-C-D) following HF societies recommendations. stage B participants were stratified according to presence/absence of HF risk factors and to the most severe echocardiographic abnormality present (reduced ejection fraction (EF), left ventricular (LV) hypertrophy/diastolic dysfunction or other abnormalities). We reported associations between physical performance metrics and HF (sub)stages.

Results
Stage B HF was present in 516 participants (24.9%). Within stage B HF, we observed a large diversity in echocardiographic profiles. Yet, stage B participants without HF risk factors (n=96, 18.6% of stage B) predominantly presented echo abnormalities other than LV diastolic dysfunction, hypertrophy and reduced EF, while their physical performance profile resembled that of people with normal echocardiography without HF risk factors. In contrast, stage B participants with HF risk factors (n=420) were characterized by LV diastolic dysfunction, hypertrophy or reduced EF, three phenotypes associated with lower 6MWT distance and lower exercise capacity. Concomitant presence of HF risk factors and LV dysfunction/hypertrophy was associated with worst physical performance.

Conclusions
We observed a wide clinical and echocardiographic diversity affecting physical performance in HF precursor stage B when defined by the current staging paradigm. Concomitant presence of HF risk factors and LV dysfunction/hypertrophy may mark individuals at highest risk for progression towards overt HF.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): This research was made supported by an institutional research grant from Verily Inc. (CA, USA) and by the Research Foundation Flanders (Belgium).
Prognostic relevance of left ventricular global longitudinal strain in patients with heart failure and reduced ejection fraction
Authors: Chimed S , Stassen J , Galloo X , Meucci M C , Van Der Bijl P , Marsan N A , Delgado V , Bax J J 
Published: October 2022

Abstract

Background
Patients with heart failure (HF) and reduced ejection fraction (HFrEF) are complex patients who often have a high prevalence of comorbidities and cardiovascular risk factors. However, risk stratification and treatment decision in these patients mainly depend on simple measurements of left ventricular (LV) ejection fraction (EF). In the present study, we investigated the prognostic significance of LV global longitudinal strain (GLS) along with important clinical and echocardiographic risk factors in patients with HFrEF.

Methods
Patients who had a first echocardiographic diagnosis of LV systolic dysfunction, defined as LVEF ≤45%, were identified. LV GLS was measured with speckle-tracking echocardiography and represented by a positive value. To divide the study population into 2 groups, spline curve analysis was used to derive the optimal threshold value of LV GLS (i.e. where the predicted hazard ratio for the endpoint was ≥1) (Figure 1). Patients were followed up for worsening HF, as well as the composite endpoint of worsening HF and all-cause mortality.

Results
A total of 2394 patients (mean age 63±12 years, 75% men) were analyzed. During a median follow-up of 60 months (interquartile range [IQR] 31–60 months), 306 patients (13%) experienced worsening HF and the composite endpoint of worsening HF and all-cause mortality occurred in 673 patients (28%). The 5-year event-free survival rates for the primary and secondary endpoint were significantly lower in the patients who had LV GLS ≤10% compared to the patients who had LV GLS &gt;10% (Figure 2A for worsening HF and Figure 2B for the composite endpoint of worsening HF and all-cause mortality). After adjustment for important clinical and echocardiographic risk factors, including HF treatments and baseline LVEF, baseline LV GLS remained independently associated with a higher risk of worsening HF (HR=0.95, 95% CI 0.90–0.99, p=0.029) and the composite of worsening HF and all-cause mortality (HR=0.94, 95% CI 0.90–0.97, p=0.001).

Conclusions
Baseline LV GLS is associated with long-term prognosis in patients with HFrEF, independently from various clinical and echocardiographic risk factors.

Funding Acknowledgement
Type of funding sources: None.
The prognostic significance of the echocardiographic evaluation of left ventricular myocardial deformation indices at peak cardiopulmonary exercise in patients with severe dilated cardiomyopathy
Authors: Triantafyllidi H , Birmpa D , Fambri A , Benas D , Ikonomidis I , Iliodromitis E K 
Published: October 2022

Abstract

Background
Cardiopulmonary exercise testing (CPET) integrally estimates exercise capacity (peak VO2) and cardiovascular (CV) prognosis (VE/VCO2 slope) in patients with dilated cardiomyopathy (DCM). Myocardial deformation indices (MDI), measured by speckle tracking imaging (STI), allow reliable measurements of left ventricular (LV) function. Little is known about the exercise-induced changes of the multidimensional mechanical properties of the heart and their impact in patient's survival. We aimed to investigate the predictive role regarding 3-year survival of LV MDI (at rest and peak exercise) as well as the main CPET parameters (peak VO2, VE/VCO2 slope) in DCM patients with reduced ejection fraction (EF) using as primary combined end-point the heart transplantation and all cause death.

Patients and methods
We evaluated LV function using STI at rest and at peak exercise during the same CPET session in 53 DCM patients (54±12 years, 76% males, ejection fraction 33±9%).We measured global longitudinal strain (GLS), longitudinal strain rate at systole (LSRS) and diastole (LSRD) at baseline and at peak CPET along with CPET parameters. After a period of 38±15 months, all DCM patients were evaluated by a telephone interview.

Results
From the whole population, totally 7 patients (13%) reached the primary end-point (Group A) as 2 patients were submitted to heart transplantation and 5 patients died (60±13 years, 86% males, EF = 28±9%) while 46 patients remained alive at 3-year follow-up (Group B, 53±12 years, 74% males, EF = 33±9%). We found that Group A patients had similar age, sex and EF but reduced peak VO2 (p=0.04) and increased VE/VCO2 slope (p=0.004), impaired GLS at baseline and peak exercise (p=0.02 and p=0.04, respectively) as well as LSRS at peak exercise (p=0.05) compared to Group B patients.

Conclusions
The evaluation of GLS (rest and peak exercise) and LSRS (peak exercise) as systolic indices of LV myocardial deformation adds valuable information regarding CV prognosis in patients with severe idiopathic DCM. A combined baseline work-up protocol consisted of MDI evaluation at rest and exercise plus the CPET indices may characterize the true severity of heart failure in a DCM population.

Funding Acknowledgement
Type of funding sources: None.
Inferior vena cava diameter adds information to pulmonary artery systolic pressure in outpatients with heart failure
Authors: Iaconelli A , Pellicori P , Maffia P , Clark A L , Cleland J G F 
Published: October 2022

Abstract

Background
Evaluation of pulmonary arterial pressure (PAP) is recommended by guidelines to diagnose and monitor congestion in patients with heart failure (HF). However, the high compliance of the venous system might buffer the effects of a large increase in intravascular volume and delay an elevation in PAP. Therefore, measuring inferior vena cava (IVC) diameter by ultrasounds might add important information in patients with HF, regardless of PAP.

Aim
To evaluate the relationship between the IVC diameter and systolic PAP (PAsP) assessed by echocardiography with mortality in outpatients with HF.

Methods
We enrolled consenting out-patients attending a community HF clinic for initial diagnosis or follow-up in Kingston upon Hull, UK between 2009–2012. HF was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either a left ventricular systolic function (LVEF) &lt;50% or elevated amino-terminal pro-brain natriuretic peptide (NT-proBNP) ≥125 pg/ml. IVC was considered dilated when &gt;2.0 cm, PAsP elevated when &gt;35 mmHg.

Results
Amongst the 874 patients enrolled, median age was 75 years, 68% were men, median LVEF was 44% and median NT-proBNP was 1125 pg/ml. 468 patients (54%) had normal IVC and PAsP, 117 (13%) had normal IVC but elevated PAsP, 75 (8%) had dilated IVC but normal PAsP and 214 (25%) had both dilated IVC and elevated PAsP. Compared to those with normal IVC and PAsP, those with elevated PAsP but normal IVC were older, more likely to be women, and had higher LVEF and NT-proBNP, whilst those with dilated IVC but normal PAsP had similar age and LVEF, but more signs of congestion and higher NT-proBNP. Compared to those with both normal IVC and PAsP (reference), those with dilated IVC but normal PAsP (HR: 1.83; CI: 1.04–3.25; P=0.037) or elevated PAsP but normal IVC (HR: 1.88; CI: 1.25–2.85; P=0.003) had a similarly increased risk of death but those with a dilated IVC and elevated PAsP had the greatest risk (HR: 4.16; CI: 3.10–5.57; P&lt;0.001).

Conclusion
A dilated IVC is associated with mortality even when PAsP is not elevated. Tailoring treatments to reduce IVC diameter is a strategy worth exploring to improve outcomes in outpatients with heart failure.

Funding Acknowledgement
Type of funding sources: None.
Which parameter of right ventricular function predicts outcome in acute heart failure
Authors: Berrill M , Ashcroft E , Baltabaeva A 
Published: October 2022

Abstract

Aims
RV systolic dysfunction is being recognised as significant prognostic marker of poor outcome in acute heart failure. We aimed to characterise the predictive capacity of RV systolic function on long term outcomes in those hospitalised in AHF.

Methods
418 consecutive AHF patients presenting over 12 months were prospectively recruited and underwent bed-side echocardiography within 24 hours of recruitment. 8 parameters of RV systolic function were assessed in predicting 2-year mortality by identifying the sensitivity and specificity associated with the maximum Youden Index. These cut-offs were used as binary determinants of outcome in unadjusted Kaplan-Meier analysis.

Results
7/8 binary assessments of RV systolic dysfunction were significantly predictive of 2 year outcome, including the tricuspid annulus systolic plane excursion (TAPSE) ≤1.6cm, RV fractional area change (RVFAC) ≤38.2%, peak systolic and end systolic RV inferior wall global longitudinal strain of &gt;−18.6% and &gt;−18%, inferior free wall average strain rate &gt;−1.8 s–1, a 2D ellipsoid model of RVEF &lt;46.9% and the ratio of the TAPSE to systolic pulmonary artery pressure &lt;0.0268 cm/mmHg (all p&lt;0.02). Crude hazard ratios ranged from 1.50–2.13. Only the RV tissue doppler imaging S wave velocity ≤0.09m/s could not delineate those at risk of poor outcome (p=0.17).

Discussion
A constellation of RV systolic assessment could effectively delineate those at risk of poor outcome following hospitalisation for AHF. The cut-offs identified were broadly similar to those from the ESC guidelines on RV chamber assessment. Only the S wave velocity from tissue doppler imaging was not predictive. This may be due to more angle dependency in measurements alongside the impact of loading conditions in acute heart failure. RV dysfunction should remain a serious focus of attention from acute physicians and echosonographers.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Abbott
Prognostic impact of echocardiographic derived precapillary wedge pressure and pulmonary vascular resistances in patients with heart failure
Authors: Giannoni A , Gentile F , Buoncristiani F , Chubuchny V , Sciarrone P , Panichella G , Bazan L , Gasperini S , Fabiani I , Taddei C , Poggianti E , Petersen C , Pasanisi E , Passino C , Emdin M 
Published: October 2022

Abstract

Background
A reliable echocardiographic algorithm for the estimation of precapillary wedge pressure (PCWP) and pulmonary vascular resistances (PVR) has been recently validated by our group in a large cohort of patients undergoing right heart catheterization (RHC) (1). Those metrics may add relevant clinical and prognostic information in patients with heart failure (HF).

Objective
To assess the clinical/prognostic significance of echocardiographic derived PCWP and PVR in a large cohort of chronic HF patients on modern treatments.

Methods
Outpatients with chronic HF with either reduced (≤40%) or mildly reduced LVEF (41–49%) underwent a thorough clinical multiparametric assessment and were followed-up for a composite endpoint of cardiac death, appropriate ICD shock, or first HF hospitalization.

Results
Out of 1,483 patients prospectively enrolled (70±12 years, 73% males, 42% ischemic etiology, LVEF 35±8%), PCWP (16.4±5.8 mmHg) was elevated (&gt;15 mmHg) in 53% of cases, while PVR (1.7±0.7) was elevated (&gt;3 WU) in 6% of cases. Of the latter group, most (92%) had also elevated PCWP. Patients with increased PCWP were older, had a higher heart rate and lower cardiac output, showed a higher degree of left and right chamber remodeling, had a higher neurohormonal activation, worse renal function, worse functional capacity and ventilatory efficiency on effort (all p&lt;0.001). Those patients with high PCWP and PVR showed higher heart rate and pulmonary pressures, lower cardiac output, and right ventricular function, higher neurohormonal activation, lower functional capacity and ventilatory efficiency on effort compared to patients with high PCWP but normal PVR (all p&lt;0.01). The optimal prognostic cut-point was identified for both PCWP (16.2 mmHg) and PVR (2 WU) by log-rank maximal likelihood ratio. Over a median follow-up of 22 (8–37) months, both measures significantly stratified patients for the risk of the primary endpoint at Kaplan-Meier analysis (log-rank 92.9, p&lt;0.001 for PCWP; log-rank 17.3, p&lt;0.001 for PVR). At multivariable Cox regression analysis (adjusted for age, sex, ischemic HF etiology, renal function, LVEF, and NT-proBNP), PCWP (hazard ratio, HR 1.77 [95% CI 1.30–2.40], p&lt;0.001) but not PVR (HR 1.15 [95% CI 0.88–1.51], p=0.31) remained an independent predictor of the primary outcome.

Conclusion
The estimation of PCWP and PVR by echocardiography add relevant clinical and prognostic information and may help in the decision making in patients with HF.

Funding Acknowledgement
Type of funding sources: None.
ARNI effects in HFrEF. Risk reduction beyond LVEF
Authors: Boehmer A A , Schubert T , Zezyk C , Kaess B , Ehrlich J R 
Published: October 2022

Abstract

Background
The imbalance of cardiac autonomic nervous system function plays an important role in heart failure associated mortality. ARNI has demonstrated a paramount effect in reducing risk of death and hospitalization for worsening of heart failure. However, its exact mechanism of action remains only partly understood. We sought to prospectively compare heart rate variability as a noninvasive measure of cardiac autonomic nervous system function.

Methods
The study design was prospective sequential observational. Patients served as their own internal control. Patients with heart failure with reduced ejection fraction (HFrEF) receiving optimal medical therapy who were scheduled for a switch to ARNI therapy underwent echocardiography and a standardized 30-minute 12-lead Holter ECG recording before starting ARNI therapy. A monitoring of the parameters was performed 3 months after the start of therapy. Physicians were instructed to increase ARNI dose to the highest tolerated or maximum dose. Besides left ventricular ejection fraction (LVEF) we assessed heart rate (HR), standard deviation of normal-to-normal intervals (SDNN) and mean square of differences between consecutive R-R intervals (RMSSD).

Results
We recruited 55 patients and baseline characteristics were as follows: age 65±12 years, male sex 78%, NT-proBNP 4989±809 pg/ml, LVEF 28±6%, HR 75±9 bpm, SDNN 43±2 ms, RMSSD 19±2 ms. All patients received beta-blocker therapy and the dosage was similar at baseline and follow-up. After 3 months of ARNI therapy, heart rate showed a significant reduction of 7% (74±14 bpm vs. 69±11 min, P=0.005). SDNN increased by 49% (43±2 ms vs. 64±4 ms, P&lt;0.001) and RMSSD by 42% (19±2 ms vs. 27±3 ms, P=0.01). These results were accompanied by increased LVEF (28±6% vs. 38±10%, P&lt;0.001) and reduced plasma NT-proBNP levels (4989±809 pg/ml vs. 2602±87 pg/ml, P&lt;0.04). NYHA Class of affected patients changed from III to II.

Conclusion
After changing from ACE/AT1-I to ARNI, significant improvement of autonomic cardiac nervous system function could be observed. ARNI apparently activates the parasympathetic nervous system as suggested by decreased HR and increased SDNN and RMSSD. Therefore, part of its cardioprotective and beneficial effects may relate to the restoration of autonomic cardiac nervous system function. Potential beneficial effects regarding incidence of sudden cardiac arrest may relate to these observations.

Funding Acknowledgement
Type of funding sources: None.
Heart failure therapy in new onset heart failure versus chronic heart failure: an analysis of 90,383 patients from the Swedish Heart Failure Registry (SwedeHF)
Authors: Shahim A , Savarese G , Dahlstrom U , Lund L H , Linde C , Hage C 
Published: October 2022

Abstract

Background
The period after newly diagnosed heart failure (HF) presents challenges in HF management. Although recent HF guidelines recommend immediate initiation of HF therapies, little is known about real life HF therapy.

Purpose
We analyzed differences in treatment management in patients with new onset and chronic HF across the ejection fraction (EF) spectrum in the large nationwide Swedish HF registry.

Methods
In patients enrolled 2000–2018 in the Swedish HF registry, clinical characteristics, co-morbidities, laboratory values and use of therapy were analyzed in all HF patients with new onset HF (HF duration &lt;3 months from diagnosis) and chronic HF (HF duration ≥3 months from diagnosis). Additionally, therapy use was studied separately for patients with HFrEF (defined as EF &lt;40%).

Results
Of 90,383 patients, 40% had new onset and 60% had chronic HF. Patients with new onset HF were more likely females (42 vs. 37%) compared to chronic HF. They had lower NYHA class, with higher EF, less often had atrial fibrillation (46 vs. 60%) and left bundle branch block (14 vs. 21%). They more often had hypertension (31 vs. 24%), and less often ischemic heart disease (34 vs. 44%), dilated cardiomyopathy (4.1 vs. 8.1%) and known alcoholic cardiomyopathy (0.6 vs. 0.8) as cause of HF. Chronic HF was associated with worse renal function (eGFR 58 [41, 77] vs. 69 [51, 87] mL/min/1.73 m2) and higher co-morbidity burden. Overall, new onset HF were less often on beta-blockers (85 vs. 88%) and MRAs (26 vs. 40%), whereas patients with chronic HF more often received HF medication and HF related device therapy. Patients with new onset HFrEF and thus with an indication for guidelines directed medical therapies were more often treated with beta-blockers (93 vs. 92%), ACE/ARB (91 vs. 83%), but less often ARNi (2.5 vs. 16%) and device therapy.

Conclusions
In this large HF population, patients with new onset HF were more often females, with less severe HF symptoms, and with fewer co-morbidities; New onset HF was associated with less MRA use. Our findings implies that faster and concomitant HF therapy initiation as recommended in 2021 ESC HF/HFA guidelines should occur in new onset HF patients.

Funding Acknowledgement
Type of funding sources: None.