bluuebunny/crossref_metadata_2025_split huggingface dataset:
Tissue inhibitor of metalloproteinase (TIMP)-1 predicts negative remodeling and recovery of ejection fraction in acute heart failure with reduced ejection fraction
Authors: Tseng C H , Huang W M , Sung S H 
Published: October 2022

Abstract

Background
Heart failure with recovered ejection fraction (HFrecEF) is a recently identified phenotype of heart failure, which had lower rates of mortality, heart failure hospitalization, ventricular assist device placement, and heart transplantation compared to heart failure with reduced ejection fraction (HFrEF). Several predictors of HFrecEF had been proposed such as female gender, lower HF duration, nonischemic cause, no left bundle branch block (LBBB), lower EF, and lower N-terminal pro-brain natriuretic peptide (NT-proBNP) in the previous studies. Tissue inhibitors of metalloproteinase-1 (TIMP-1) was a biomarker that regulated the activity of metalloproteinases (MMPs). TIMP-1 was up-regulated during HF and was associated with ventricular remodeling and poor prognosis. However, the predictive value of TIMP-1 and MMP-9 in recovery of EF was yet to be investigated.

Purpose
The present study aimed at investigating the predictive value of TIMP-1 and MMP-9 of recovery of EF.

Methods
Subjects with acute decompensated heart failure and reduced left ventricular ejection fraction were eligible for this study. HFrEF was defined as EF &lt;40% and HFrecEF was defined as follow-up EF ≥40% and ≥10% improvement from baseline EF. The biomarkers including NT-proBNP, plasma MMP-9 and serum TIMP-1 were measured in all enrolled subjects at admission. The receiver operating characteristic (ROC) curves and Youden index were used to select the model variables and cutoff values. Binary logistic regression analysis assessed the association between the biomarkers and recovery ejection fraction.

Results
Among a total of 91 AHF with reduced ejection fraction subjects (70.1±16.2 years, baseline EF 28.9±7.6%), 19 (20.8%) HFrecEF and 72 (79.2%) persistent HFrEF were found at 6 months. TIMP-1 and NT-proBNP were significantly higher in persistent HFrEF compared to HFrecEF. MMP-9 was similar between these two phenotypes of HF. The area under the ROC curve for recovery of ejection fraction of TIMP-1, MMP-9 and NT-proBNP were 0.69, 0.52, and 0.65, respectively. The optimal cutoff value of TIMP-1 according to Youden index was 200.68 ng/ml. In binary logistic regression analysis, TIMP-1 was negatively correlated with recovered ejection fraction as continuous variables [per 1-SD=8.96 ng/ml, odds ratio and 95% confidence interval: 0.99 (0.98–1.00)] and categorical variables [cutoff value 200.68 ng/ml, odds ratio and 95% confidence interval: 0.16 (0.05–0.54)] after adjusting age, gender, EF, acute myocardial infarction, LBBB and NT-proBNP.

Conclusions
In AHF subjects with HFrEF, TIMP-1 was negatively correlated to the recovery of EF and could be a potential biomarker for the prediction of the recovery of EF.

Funding Acknowledgement
Type of funding sources: None.
Dynamic right ventricular structural and functional changes in acute decompensated heart failure, new insights from serum sST2 and speckle-tracking echocardiography imaging
Authors: Kamal A , Darwish R , Abdel Hamid M , Hassan M 
Published: October 2022

Abstract

Background
Right ventricular (RV) mechanics are affected by volume/pressure overload in acute decompensated heart failure (ADHF) which can be detected using biomarkers and echocardiography. ST2 (suppression of tumorigenicity 2) is a biomarker of myocardial fibrosis and remodeling, that has been studied in patients with ADHF. Although baseline serum soluble ST2 (sST2) values at ADHF admission have been proved to predict outcomes, serial measurements are even of greater value.

Purpose
To evaluate the right ventricular dynamic structural and functional changes in ADHF patients during hospitalization, using serum sST2 and speckle-tracking echocardiography imaging.

Methods
We prospectively enrolled 61 ADHF patients with LV ejection fraction less than 50% and serum NT-proBNP more than 900 pg/ml. All patients received intravenous diuretics and did not require inotropic support during hospital stay. Blood samples were collected to measure serum sST2 levels on hospital admission and discharge. All patients underwent serial conventional and speckle tracking echocardiography on admission, at 48 hours and on hospital discharge. RV speckle tracking echocardiography analysis was done using 2D Cardiac Performance Analysis version 4.6.

Results
Serum sST2 had significant strong positive correlation with serum NT-proBNP on admission (r=0.84, P&lt;0.0001) and showed significant reduction from 2.47 (1.27–4.05) ng/ml on admission to 1.86 (1.06–3.24) ng/dl at hospital discharge (P&lt;0.0001) denoting successful decongestion. There was significant decrease in inferior vena cava diameter (P&lt;0.0001) and estimated pulmonary artery systolic pressure (EPASP) (P=0.002) throughout hospital stay, however this was not associated with significant change in RV dimensions (P&gt;0.05) or contractility assessed by trans-annular plane systolic excursion (TAPSE) (P=0.09) and S-wave velocity at lateral tricuspid annulus (P=0.9). There was significant improvement in RV free wall strain (RVFWS) (P=0.005) assessed by speckle tracking echocardiography which was mainly noticed after the first 48 hours till discharge, but RV 4-chamber strain (RV4CS) did not change significantly (P=0.06).

Conclusions
RVFWS assessed by speckle tracking echocardiography can detect improvement in RV systolic function not detected by other conventional echocardiographic parameters in ADHF patients. Improvement in RVFWS together with decline in serum sST2 levels can be used as marker of improved cardiac mechanics and successful decongestion.

Funding Acknowledgement
Type of funding sources: None.
Meta-analysis comparing the efficacy of dobutamine versus milrinone in acute decompensated heart failure and cardiogenic shock
Authors: Bandyopadhyay D , Malik A , Goel A , Biswas S , Hajra A , Gupta R , Lanier G , Naidu S 
Published: October 2022

Abstract

Objective
This study aims to evaluate the difference between dobutamine and milrinone in patients presenting with acute decompensated heart failure (AHF).

Background
Inotropes are indicated for treating AHF, especially in patients with concomitant hypoperfusion indicative of cardiogenic shock. However, previous studies have not identified the optimal inotrope. We sought to compare outcomes associated with milrinone versus dobutamine in patients with AHF.

Methods
A systematic literature search was performed to identify relevant trials from inception to August 2021. Our primary outcome of interest was mortality. Analysis was sub-categorized according to subpopulation, including AHF, AHF with cardiogenic shock (AHF-shock), AHF with a bridge to transplantation (AHF-BTT), and AHF with destination therapy (AHF-DT). Summary effects were calculated using a fixed-effects model as risk ratio or mean difference with 95% confidence intervals for all the clinical endpoints.

Results
Ten studies, including one randomized controlled trial with 21,106 patients, were included in the analysis (4918 patients were in the Milrinone group, while 15188 were in the Dobutamine group). Milrinone was associated with a lower risk of mortality in patients with AHF [relative risk (RR) 0.87; confidence interval (CI):0.79–0.97; p&lt;0.05, heterogeneity I2=0%] with event rates of 9.4% vs. 9.8% [number needed to treat (NNT) of 250]. Milrinone was also associated with improved mortality with RR 0.76 (0.79–0.95; p&lt;0.05) in patients with AHF-DT. There was a non-significant trend towards improved mortality in AHF-shock patients. However, AHF-BTT patients had a non-significant trend towards improved mortality with dobutamine. There was no difference between the two strategies for the outcomes of acute kidney injury, initiation of renal replacement therapy, mechanical ventilation, arrhythmias, symptomatic hypotension, and length of hospital stay (LOS) in the overall population. Intensive care unit (ICU) LOS was lower in AHF-shock patients in the milrinone group, whereas dobutamine was associated with a lower length of ICU stay in AHF patients.

Conclusion
The cumulative data comparing milrinone with dobutamine indicate an overall marginal benefit of milrinone compared to dobutamine in the totality of patients with AFH with or without cardiogenic shock, and whether or not they are bridged to transplantation or destination assist device. More appropriately powered prospective studies are needed to identify a conclusive benefit of one inotrope over another.

Funding Acknowledgement
Type of funding sources: None.
Pressure-strain loops unveil hemodynamics behind mechanical circulatory support systems
Authors: Landra F , Mandoli G E , Sciaccaluga C , Gallone G , Pica A , Cavigli L , D'Ascenzi F , Focardi M , Maccherini M , Bernazzali S , Valente S , Cameli M 
Published: October 2022

Abstract

Background
Mechanical circulatory support (MCS) systems are increasingly employed in critical hemodynamic states, such as in cardiogenic shock and end-stage heart failure. A thorough understanding of the complex interactions occurring between heart, vasculature and device is essential to optimize patient's management.

Purpose
This study aimed to explore the hemodynamic profile of patients under MCS using a non-invasive method based on pressure-strain analysis.

Methods
Consecutive patients admitted to the cardiological intensive care unit (CICU) from August 2021 to January 2022 undergoing different MCS systems positioning/implantation were retrospectively reviewed. Patients without a useful echocardiographic exam and/or arterial blood pressure invasive measurement at the time of echocardiography were excluded. Myocardial work analysis by Speckle Tracking Echocardiography (STE) was performed in these patients.

Results
3 patients with intra-aortic balloon pump (IABP), 2 patients with durable left ventricular assist device (dLVAD), 2 patients with temporaneous left ventricle (LV)-to-aortic pump, 1 patient with extracorporeal membrane oxygenation (ECMO) and 1 patient with ECMO and IABP were included. The use of IABP shifted the pressure-strain curve rightward and downward. Global work index (GWI) and global wasted work (GWW) decreased after IABP positioning, whereas global work efficiency (GWE) increased. The use of continuous-flow LV-to-aortic pumps, whether temporaneous or long-term (dLVAD), induced a significant change in the pressure-strain loop, with a shift towards a triangular shape. ECMO positioning alone resulted in a narrowing of the pressure-strain loop, with a decrease in GWI and GWE and an increase in GWW and mean arterial pressure. The combined used of IABP with ECMO widened the pressure-strain loop and improved GWI and GWE.

Conclusions
Pressure-strain loops unveil hemodynamic variations induced by mechanical circulatory support systems. Thus, myocardial work could be used to monitor ventricular-arterial-device coupling in such patients and therefore guide tailored management.

Funding Acknowledgement
Type of funding sources: None.
Differences in microRNA expression in pericoronary tissue adjacent to atherosclerotic plaque and from lesion-free coronary artery
Authors: Marketou M , Kontaraki J , Kalogerakos P , Plevritaki A , Pateromichelakis T , Kassotakis S , Maragkoudakis S , Kampanieris E , Zervakis S , Savva E , Mpantouvakis G , Lazopoulos G , Kochiadakis G 
Published: October 2022

Abstract

Background
Pericoronary adipose tissue (PCAT) plays a key role in the pathogenesis of atherosclerosis. PCAT is a source of microRNAs (miRs) that acts as messengers for intercellular communication. In this study, we investigated whether the PCAT surrounding coronary occlusive atherosclerotic lesions shows specific miR expression patterns compared to PCAT surrounding plaque-free segments.

Purpose
To evaluate the expression of miRs that are known to be implicated in the pathophysiology of atherosclerosis.

Methods
We included 49 patients (38 men, age 65±9 years) with 3-vessel coronary artery disease, who underwent elective coronary bypass surgery. The PCAT was harvested from two sites: adjacent to an occlusive atherosclerotic coronary lesion, and a plaque-free segment. miR-133a, miR-21, miR-26b, miR-9 and miR-143 levels in PCAT cells were quantified by real-time reverse transcription polymerase chain reaction.

Results
miR-26b, miR-21 and miR-143 showed significantly greater expression in PCAT samples taken from around atheromatous plaque (154±295 versus 37±96, p=0.014, for miR-26b; 122±265 versus 29±79, p=0.014, for miR-21; and 181±356 versus 31±50, p=0.03, for miR-143) (Figure 1). In addition, the expression of miR-143, miR-26b and miR-21 in PCAT from atherosclerotic plaque showed robust positive correlations with body.mass index (r=0.451, p=0.001, r=0.41, p=0.03 and r=0.416, p=0.003 respectively),

Conclusions
Analysis of PCAT located in proximity to atherosclerotic plaque showed a different pattern of miR expression compared to PCAT in a plaque-free segment. Our findings open new perspectives for the role of PCAT in the pathophysiological mechanisms of atherosclerotic disease and should be further investigated.

Funding Acknowledgement
Type of funding sources: None.
Pressure- and 3D-derived coronary flow reserve with hydro-static pressure correction: a validation by intracoronary Doppler measurements
Authors: Tar B , Agoston A , Uveges A , Szabo G T , Szuk T , Komocsi A , Czuriga D , Csippa B , Paal G , Koszegi Z 
Published: October 2022

Abstract

Purpose
To develop a method of coronary flow reserve (CFR) calculation derived from three-dimensional (3D) coronary angiographic parameters and intracoronary pressure data during fractional flow reserve (FFR) measurement.

Methods
Altogether 19 coronary arteries of 16 native and 3 stented vessels were reconstructed in 3D. The measured distal intracoronary pressures were corrected to the hydrostatic pressure based on the height differences between the levels of the vessel orifice and the sensor position. Classical fluid dynamic equations were applied to calculate the flow during the resting state and vasodilatation on the basis of morphological data and intracoronary pressure values. 3D-derived coronary flow reserve (CFRp-3D) was defined as the ratio between the calculated hyperemic and the resting flow and was compared to the CFR values simultaneously measured by the Doppler sensor (CFRDoppler).

Results
Haemodynamic calculations using the distal coronary pressures corrected for hydrostatic pressures showed a strong correlation between the individual CFRp-3D values and the CFRDoppler measurements (r=0.89, p&lt;0.0001). Hydrostatic pressure correction increased the specificity of the method from 46.1% to 92.3% for predicting an abnormal CFRDoppler &lt;2.

Conclusions
CFRp-3D calculation with hydrostatic pressure correction during FFR measurement facilitates a comprehensive haemodynamic assessment, supporting the complex evaluation of macro- and microvascular coronary artery disease.

Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): University of Debrecen
Ventricular and vascular stiffening in ischemia with no obstructed coronary arteries: novel insight from pressure-volume analysis
Authors: Oneglia A P , Wei J , Samuels B , Jake Samuel T , Azarbal B , David Anderson R , Petersen J W , Cook-Weins G , Pepine C J , Noel Bairey Merz C , Nelson M D 
Published: October 2022

Abstract

Background
Ischemia with no obstructed coronary arteries (INOCA) is prevalent among women and associated with an increased risk of developing heart failure with preserved ejection fraction (HFpEF), however the mechanism linking these conditions remains poorly understood. Coronary vascular dysfunction is common in INOCA, representing a putative mechanism driving heart failure progression.

Purpose
To evaluate the role of coronary vascular dysfunction on left ventricular (LV) function in women with INOCA.

Methods
Women with suspected INOCA, defined as having signs and symptoms of ischemia but no obstructive coronary artery disease, underwent LV pressure-volume assessment at rest and during 3 minutes of isometric handgrip stress at 30% of maximal voluntary contraction. Coronary function testing was performed by infusing standard doses of adenosine, acetylcholine, and nitroglycerine through a guiding catheter placed in the left main coronary artery, per our published protocols. Using standardized definitions of normal versus abnormal responses, cases with zero abnormal coronary pathways (n=12) were compared to cases with three abnormal coronary pathways (n=7).

Results
At rest, end-systolic pressure and end-systolic elastance were elevated in cases with abnormal coronary vascular function (Figure), while normalized peak filling rate was lower (0.45±0.15 s mmHg–1 vs 0.37±0.08 s mmHg–1). With isometric handgrip, end-systolic pressure and end-systolic elastance increased similarly between groups, remaining highest in those with abnormal coronary vascular function (Figure). End-diastolic pressure-volume declined with handgrip in those without coronary vascular dysfunction, while increasing (up and to the left) in those with coronary vascular dysfunction (Figure). Likewise, normalized peak filling rate improved with handgrip in those without coronary vascular dysfunction, but did not change in those with coronary vascular dysfunction (0.66±0.37 s mmHg–1 vs 0.38±0.15 s mmHg–1).

Conclusions
We show heightened ventricular and vascular stiffness in women with INOCA who have abnormal coronary vascular function. These preliminary data support the hypothesis that coronary vascular dysfunction may be a putative mechanistic pathway driving heart failure progression in INOCA.

Funding Acknowledgement
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Institutes of Health
Relative monocytosis predicts the presence and severity of coronary artery disease on CT coronary angiography in patients with stable angina symptoms
Authors: Spray L , Beattie A , Spyridopoulos I 
Published: October 2022

Abstract

Background
Monocytes, among other leucocytes, are crucially involved in the pathogenesis of atherosclerosis, but the value of peripheral blood leucocyte counts in predicting the presence or absence of atherosclerotic coronary artery disease (CAD) is unknown.

Purpose
Investigating whether circulating counts of monocytes, lymphocytes and neutrophils predict CAD on computed tomography coronary angiography (CTCA) in patients presenting with stable chest pain.

Methods
All patients investigated with CTCA in our centre in the year 2021 were screened (n=1564). Patients presenting via the Rapid Access Chest Pain clinic were retrospectively identified, and those with a Full Blood Count from the 6 months prior to clinic were included (n=330). Traditional cardiovascular risk factors were ascertained from the clinic letter. CAD was defined as any epicardial stenosis &gt;25% on CTCA. Patients with CAD were further classified as having either single or multivessel disease (left main stem disease was considered multivessel), and non-obstructive or obstructive disease (any stenosis &gt;70% was considered obstructive).

Results
Patients with CAD had significantly higher mean monocyte count than those without CAD (0.61 vs. 0.55x109/L, p=0.004), while no differences were observed between groups in lymphocyte or neutrophil count. Monocyte count increased further with more severe CAD, being higher in patients with multivessel compared to single-vessel disease (0.62 vs. 0.60x109/L; p for trend including no CAD =0.012), and in patients with obstructive compared to non-obstructive disease (0.62 vs. 0.60x109/L; p for trend including no CAD=0.012).
The association between monocytes and CAD was most marked among patients with a history of hypercholesterolaemia (monocyte count in CAD vs. no CAD: 0.63 vs. 0.54x109/L, p=0.001), and was absent in those without (0.57 vs 0.56x109/L, p=0.695). In the hypercholesterolaemia subgroup (n=186), a forward conditional logistic regression model including monocyte count alongside traditional risk factors (age, sex, smoking status, diabetes mellitus, hypertension, cholesterol level and family history), showed that only increasing age (p&lt;0.001), male sex (p&lt;0.001) and increasing monocyte count (p=0.01) were independently predictive of CAD.

Conclusion
Raised monocyte count is associated with both the presence and severity of coronary artery disease in patients presenting with anginal symptoms. In patients with a history of hypercholesterolaemia, monocyte count had a more robust predictive ability than many traditional cardiovascular risk factors. Further work is needed to establish whether patients with a relative monocytosis have a higher cardiovascular risk than would be predicted by traditional risk tools.

Funding Acknowledgement
Type of funding sources: None.
Patterns and outcomes of cardiovascular emergency department encounters for men and women in the USA
Authors: Kobo O , Raisi-Estabragh Z , Elbadawi A , Velagapudi P , Sharma G , Petersen S E , Roguin A , Mamas M A 
Published: October 2022

Abstract

Aims
We described sex-differential disease patterns and outcomes of over 20.6 million cardiovascular emergency department (ED) encounters in the USA.

Methods and results
We analysed primary cardiovascular encounters from the Nationwide Emergency Department Sample (between 2016–2018). We grouped the documented cardiovascular diagnoses into 15 disease categories. The sample included 48.7% women; average age was 67 [54,78] years. Men had greater overall baseline co-morbidity burden; however, women had higher rates of obesity, hypertension, and cerebrovascular disease. For women, the most common ED encounters were essential hypertension (16.0%), hypertensive heart or kidney disease (14.1%), and atrial fibrillation (AF)/flutter (10.2%). For men, the most common encounters were hypertensive heart or kidney disease (14.7%), essential hypertension (10.8%), and acute myocardial infarction (AMI, 10.7%). Women were more likely to present with essential hypertension, hypertensive crisis, AF/flutter, supraventricular tachycardia, pulmonary embolism, or ischaemic stroke. Men were more likely to present with AMI or cardiac arrest. In logistic regression models adjusted for baseline covariates, women with intracranial haemorrhage had higher risk of hospitalisation and death. Women with ischaemic stroke had higher risk of hospitalisation and death in ED. Women presenting with pulmonary embolism were less likely to be hospitalised but were more likely to die. Women with aortic aneurysm/dissection had higher risk of hospitalisation and death. Men were more likely to die following presentations with hypertensive heart or kidney disease, AF/flutter, AMI, or cardiac arrest.

Conclusion
In this large nationally representative sample of cardiovascular ED presentations, we demonstrate significant sex differences in disease distribution, hospitalisation, and death.

Funding Acknowledgement
Type of funding sources: None.