bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cardiac magnetic resonance radiomics for prediction of incident heart failure: a feasibility study in the UK Biobank Imaging cohort
Authors: Szabo L , Ruiz Pujadas E , McCracken C , Izquierdo C , Campello V M , Atehortua A , Petersen S E , Lekadir K , Raisi-Estabragh Z 
Published: October 2022

Abstract

Background
Cardiac magnetic resonance (CMR) radiomics is a novel image quantification technique with the potential to improve image-based disease diagnosis and prediction.

Purpose
In this proof-of-concept study, we aimed to evaluate the utility of CMR radiomics in the prediction of incident heart failure (HF).

Methods
We studied 32,121 UK Biobank participants with CMR. Incident HF was defined from linked Hospital Episode Statistics. To create a balanced cohort, we identified as comparators an equal number of randomly selected subjects who did not develop the outcome of interest during this period. Radiomics shape, first-order and texture features were extracted from short-axis cine images (left and right ventricle, left ventricular myocardium) using the Pyradiomics toolbox. Vascular risk factors (VRFs) were considered as additional predictors. Feature selection was conducted using the sequential forward selection technique and modelling was performed using Support Vector Machine (SVM) methods with 5-fold cross-validation. Models were developed using 1) VRFs alone, 2) radiomics alone, and 3) VRFs and radiomics. We determined model performance using receiver operating characteristic (ROC) curve and area under the curve (AUC) scores.

Results
Over average follow-up time of 3.7 (±1.3) years, 209 participants experienced incident HF. Among vascular risk factors, age, body size, hypertension, diabetes, high cholesterol were chosen for the incident HF predictive model (Accuracy: 0.66, AUC: 0.73) by the SVM methods. The model based on radiomics features reached a marginal improvement compared to vascular risk factors alone (Accuracy: 0.71, AUC: 0.75). The combination of VRFs and radiomics features significantly improved the performance of the model to predict incident HF compared to VRFs alone (Accuracy: 0.77; AUC: 0.83; p&lt;0.05)

Conclusion
We demonstrate the feasibility of CMR radomics features to predict incident HF and illustrate their added value over vascular risk factors.

Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding.
Clinical and prognostic significance of left ventricular outflow tract velocity time integral (LVOT-VTI) in patients with chronic heart failure
Authors: 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 , Giannoni A 
Published: October 2022

Abstract

Background
The echocardiographic evaluation of cardiac output relies on the product of the flow across the left ventricular outflow tract (LVOT), estimated through its velocity time integral (LVOT-VTI), and its cross-sectional area, estimated through the formula πr2. Considering the geometrical assumption behind such formula, LVOT-VTI has been proposed as a more reproducible surrogate of cardiac systolic function and showed prognostic value in the critical care setting. However, the role of such measure in patients with chronic heart failure (HF) remains unexplored.

Objective
To assess the clinical and prognostic significance of LVOT-VTI in a contemporary cohort of patients with chronic HF.

Methods
Outpatients with chronic HF with a LV ejection fraction &lt;50% were prospectively enrolled to undergo a clinical, echocardiographic, and biohumoral assessment, and were followed-up for the endpoint of all-cause death.

Results
Finally, 971 patients were enrolled (71±12 years, 72% men, 50% ischemic etiology, LVEF 35±9%). Most patients showed a NYHA class I-II (74%) and were treated with ACE-inhibitors/ARBs or ARNI (81%), beta-blockers (95%), and mineralocorticoid receptor antagonists (71%). Patients were distinguished in three subgroups according to LVOT-VTI tertiles &lt;19 (n=324), 19–24 (n=324), or ≥24 (n=323). Compared with the other two subgroups, patients with LVOT-VTI &lt;19 showed worse NYHA class, lower LVEF and tricuspid annular plane systolic excursion (TAPSE), and higher E/e', left atrial volume index (LAVi), estimated systolic pulmonary arterial pressure (sPAP), and NT-proBNP concentration (all p&lt;0.001). No differences were observed as for patients' age, HF etiology, and therapies (all p&gt;0.05). Over a median follow-up of 22 (9–34) months, 103 (11%) patients met the primary endpoint. LVOT-VTI significantly stratified the risk of death, observing 65 (20%), 21 (7%), and 17 (5%) events across the subgroups with values &lt;19, 19–24, or ≥24 (log-rank 33, p&lt;0.001). At multivariable regression analysis, LVOT-VTI &lt;19 (HR 2.06 [95% 1.21–3.49], p=0.008), but not LVEF &lt;30% (p=0.614) was an independent predictor of all-cause death in a model adjusted for age, sex, ischemic etiology, renal function, hemoglobin, E/e', LAVi, TAPSE, sPAP, and NT-proBNP.

Conclusion
LVOT-VTI is associated with disease severity and is a strong predictor of all-cause death in patients with chronic HF.

Funding Acknowledgement
Type of funding sources: None.
Prevalence of abnormalities on cardiac MRI in unselected patients after recovery from acute SARS-CoV-2 infection and correlation with markers of immunity and coagulation: the SETANTA study
Authors: Colleran R , Byrne R J , Cradock A , O Ciardha D , McKeogh S , Wilson H , Mansur A , Bisset J , Cantwell G , Hannan M , Fitzgibbon M , O Donnell J , Rai H , Byrne R A 
Published: October 2022

Abstract

Background
Previous studies have reported ongoing cardiac inflammation as assessed by cardiac magnetic resonance imaging (CMR) in a significant proportion of patients several months after recovery from SARS-CoV-2 infection, many of whom had no or minimal symptoms at the time of infection.

Purpose
The aim of SETANTA was to investigate the prevalence of cardiac abnormalities by CMR in unselected patients in Ireland after acute SARS-CoV-2 infection and the correlation with immunological response and biomarkers of coagulation.

Methods
This was a prospective, observational, community-based study (clinicaltrials.gov identifier NCT04823182). Consecutive patients recovered from recent SARS-CoV-2 infection at 3 primary care sites were invited to participate. Key inclusion/exclusion criteria and outcomes of interest are shown in Figure 1.

Results
100 participants were enrolled (Feb-Sept 2021) at a median of 188 (IQR, 125, 246) days after positive SARS-CoV-2 swab. At index infection, 18% and 35% reported severe and moderate symptoms, respectively; 14% were hospitalized; 3% were admitted to intensive care for ventilatory support. At enrolment, 83% had ongoing symptoms. 85% had detectable SARS-CoV-2 antigens. CMR and laboratory findings are shown in Figure 1.

Conclusion
Among an unselected cohort of patients recovered from acute SARS-CoV2 infection, we report a low prevalence of cardiac abnormalities by CMR, despite a high prevalence of moderate/severe symptoms at presentation and a high prevalence of persistent symptoms. Correlation with biomarkers of immunity and coagulation will be available at ESC 2022.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): WomenAsOne
Safety and efficacy of SGLT2 inhibitors in diabetic and non-diabetic heart failure patients, a meta-analysis of randomized controlled trials
Authors: Awad A K , Tarek Hasan M , Shih M , N Attia A , Aboeldahab H , Bendary M , Bendary A 
Published: October 2022

Abstract

Background
Heart failure (HF) is the most common cardiovascular causes of hospitalization in people over 60 years affecting about 64.3 million people worldwide. Few studies have investigated sodium glucose like transporter-2 inhibitors (SGLT-2I) role in diabetic and non-diabetic patients with HF.

Objective
We conducted our meta-analysis to further investigate SGLT-2I role in diabetic and non-diabetic HF patients.

Methods
PubMed, Scopus, web of science, and Embase were searched. All clinical trials that compared the effect of SGLT2 inhibitors versus placebo on heart failure patients were included. Dichotomous data were extracted, pooled as risk ratio (RR) with 95% confidence interval, and analyzed via RevMan version 5.3 for windows using Mantel Haenszel (M-H) method.

Results
Twelve randomized clinical trials were included for analysis with a total number of 69024 patients. SGLT2I significantly lowered the risk of hospitalization for heart failure (HHF) in diabetic (RR=0.68, 95% CI 0.63–0.74) and non-diabetic patients (RR=0.75, 95% CI 0.62–0.89). Also, it significantly lowered mortality risk in both diabetic (RR=0.87, 95% CI 0.77–0.99) and non-diabetic patients (RR=0.93, 95% CI 0.70–1.23). Further analyses for serious adverse events were conducted, and SGLT-2I showed a significant lower risk in diabetic (RR=0.94, 95% CI 0.90–0.98) and non-diabetic patients (RR=0.72, 95% CI 0.38–1.39), yet with no observed difference over placebo in the risk of stroke.

Conclusion
SGLT2 inhibitors showed a favorable effect in lowering cardiovascular mortality, HHF, and stroke in diabetic patients with heart failure. In non-diabetic patients, they significantly reduce HHF, yet with no difference on cardiovascular mortality and stroke. Therefore, more trials are needed to establish their effect in non-diabetic patients.

Funding Acknowledgement
Type of funding sources: None.
Impact of atrial flow regulator implantation on survival in patients with heart failure with reduced and preserved ejection fraction: a post-hoc analysis of the PRELIEVE study
Authors: Lauder L , Bergmann M , Paitazoglou C , Ozdemir R , Iliadis C , Bartunek J , Lauten A , Keller T , Weber S , Sievert H , Anker S D , Mahfoud F 
Published: October 2022

Abstract

Purpose
This analysis aims to assess the theoretical impact of atrial flow regulator implantation on mortality by comparing the observed survival rate with the median predicted probability for one-year survival.

Methods
The prospective, multicentre, open-label, non-randomised PRELIEVE study assessed the safety and efficacy of the atrial flow regulator in patients with symptomatic HFrEF (left ventricular ejection fraction (LVEF) ≥15% and &lt;40%) or HFpEF (LVEF ≥40% and &lt;70%) and elevated PCWP (≥15mmHg at rest or ≥25mmHg during exercise). In this analysis, after the first 60 patients completed twelve months of follow-up, the theoretical impact of atrial flow regulator implantation on survival was assessed by comparing the observed mortality rate with the median predicted probability for one-year mortality. Each subject's risk of mortality was predicted from individual baseline data using the Meta-Analysis Global Group in Chronic HF (MAGGIC) prognostic model.

Results
A total of 87 patients had undergone successful device implantation for the treatment of HFrEF (53%) and HFpEF (47%). Sixty patients had a complete twelve-month follow-up. The median follow-up was 351 days (interquartile range [IQR] 202–370). A total of six (7%) patients died during follow-up (8.6 deaths per 100 patient-years; 95% confidence interval [CI] 2.7 to 15.5), all of which had HFrEF. The median predicted mortality rate for the overall study population was 12.2 deaths per 100 patient-years (95% CI 10.2 to 14.7). While the observed mortality rate (0 deaths per 100 patient-years) was significantly lower than the median predicted mortality rate (9.3 deaths per 100 patient-years; 95% CI 8.4 to 11.1) in patients with HFpEF (−9.3 deaths per 100 patient-years; 95% CI −11.1 to −8.4), there was no difference in patients with HFrEF (−3.6 deaths per 100 patient-years; 95% CI −9.5 to 3.0) (Figure 1). Four deaths were HF-related deaths (5.7 HF-related deaths per 100 patient-years; 95% CI 1.4 to 11.9; 10.8 HF-related deaths per 100 patient-years; 95% CI 2.5 to 23.1 in the HFrEF subgroup).

Conclusion
In patients with HFpEF, the mortality rate following atrial flow regulator implantation was lower than the predicted mortality rate. These findings need to be confirmed by larger randomised, controlled trials.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Occlutech International AB
Alcohol abstinence vs. persistent alcohol consumption in alcoholic cardiomyopathy: impact on long-term prognosis
Authors: Cediel Calderon G , Lopez H , Domingo M , Codina P , Santiago E , Borrellas A , Gonzalez B , Rivas C , Crespo E , Pulido A , Velayos P , Barcelo E , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Alcoholic Cardiomyopathy (ACM) remains a prevalent form of toxic-induced heart damage. Whether ACM prognosis depends on the persistence of alcohol consumption is a matter of debate.

Purpose
We sought to determine predictors of adverse events during long-term follow-up and left ventricular ejection fraction (LVEF) changes between abstainers and non-abstainers.

Methods
Consecutive patients admitted to a HF clinic from 2001 to 2020 with ACM were included. The primary endpoint was the composite of all-cause death or HF hospitalization. HF hospitalization was analyzed as a secondary outcome. Changes in LVEF at 1- and 3-years follow-up according to discontinuation of alcohol consumption was also analyzed. Multivariable Cox regression analyses were performed using the competing risk strategy for the secondary endpoint.

Results
A total of 122 patients were included with a mean age of 57.8±10.0 years and 95.1% (n=116) of males. The mean LVEF was 27.5% ± 10.6 and 11.5% (n=14) exhibited NYHA functional class 3. A total of 92 (75.4%) patients remained abstinent during follow-up; the rest continued with at least moderate alcohol intake. After a median follow-up of 6.8 years (interquartile range: 3.2 to 11.3 years), 59 (48.4%) presented the primary endpoint (45 [36.9%] died and 34 [27.9%] experienced HF readmission). Independent predictors of the primary outcome were age (hazard ratio [HR]: 1.03; 95% confidence interval [CI]: 1.00–1.06; p=0.042), hemoglobin (HR: 0.68; 95% CI: 0.56–0.82; p&lt;0.001) and alcohol abstinence (HR: 0.35; 95% CI: 0.20–0.61; p&lt;0.001). Predictors of HF readmission were hemoglobin (HR: 0.65; 95% CI: 0.50–0.83; p=0.001) and alcohol abstinence (HR: 0.39; 95% CI: 0.17–0.92; p=0.032). Improvement in LVEF was higher in abstainers (27.5±10.6% from baseline to 46.7±13.1% and 49.1±14.3% at 1- and 3-years respectively) than in non-abstainers (27.8±10.3% to 40.3±14.0% and 39.2±16.3% at 1- and 3-years respectively), being these changes in LVEF significantly different between both groups (p=0.004).

Conclusions
Patients with ACM and who remain abstainers during follow-up exhibit better outcomes and higher LVEF improvement in comparison to non-abstainers. These findings should help to inform lifestyle modification for patients with ACM.

Funding Acknowledgement
Type of funding sources: None.
Increasing the class of foundational medication for heart failure is associated with improved prognosis in hospitalized patients with heart failure with reduced or mildly reduced ejection fraction
Authors: Ito M , Maeda D , Matsue Y , Shiraishi Y , Dotare T , Sunayama T , Nogi K , Kohsaka S , Yoshikawa T , Saito Y , Minamino T 
Published: October 2022

Abstract

Aim
To clarify the association between changes in the number of foundational medications for heart failure (FMHF) during hospitalization for worsening heart failure and post-discharge prognosis.

Methods and results
We retrospectively analyzed a combined dataset of three large-scale registries of hospitalized patients with heart failure in Japan (NARA-HF, WET-HF, and REALITY-AHF) and included patients already diagnosed with heart failure with reduced or mildly reduced left ventricular ejection fraction (HFr/mrEF) before admission. Patients were stratified by changes in the number of prescribed FMHF classes, namely angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, beta blockers, and mineralocorticoid receptor blockers, from admission to discharge. The primary endpoint was defined as the combined endpoint of heart failure rehospitalization and all-cause death within 1-year of discharge. The cohort consisted of 1,113 patients, and 482 combined endpoints were observed. In total, 413 (37.1%) patients were on increased FMHF (increased group), 607 (54.5%) remained unchanged (unchanged group), and 93 (8.4%) had a decreased number of FMHF (decreased group) at discharge compared to the time of admission. In multivariable analysis, the increased group was associated with a significantly lower incidence of the primary endpoint compared with the unchanged group (hazard ratio 0.56, 95% confidence interval 0.45–0.60; P&lt;0.001) and decreased group (hazard ratio 0.58, 95% confidence interval 0.40–0.84; P=0.004).

Conclusion
Increasing the number of FMHF cases during heart failure hospitalization is associated with a better prognosis in patients with HFr/mrEF.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): REALITY registry was funded by the Cardiovascular Research Fund of Japan.WET-HF registry was supported by a Grant-in-Aid for Young Scientists (Y.S. JSPS KAKENHI, 18K15860).
Effect of diuretic down-titration on pulmonary congestion assessed by lung ultrasound when introducing sodium-glucose cotransporter 2 inhibitors
Authors: Domingo M , Teis A , Alonso N , Julian T , Bares D , Barcelo E , Revuelta-Lopez E , Gonzalez B , Codina P , Cediel G , Santiago-Vacas E , Santesmases J , Zamora E , Lupon J , Bayes-Genis A 
Published: October 2022

Abstract

Background
Mechanistic pathways of sodium-glucose cotransporter 2 inhibitors (SGLT2i) benefits in heart failure (HF) remain unclear.

Purpose
To investigate the effects of SGLT2i and simultaneous diuretic down-titration on pulmonary congestion assessed by lung ultrasound (LUS) and by HF biomarkers.

Methods
Prospective observational study in outpatients with HF and type 2 diabetes assigned to a SGLT2i. LUS was performed at baseline (just before starting SGLT2i), at 15 days and at 3-months of follow-up. Eight thoracic areas were examined. Diuretic regime was reduced at baseline, when LUS and clinical assessment allowed. The main outcome was short-time change in B-lines sum. Secondary endpoints evaluated N-terminal pro-B-type natriuretic peptide (NTproBNP), cancer antigen 125 (CA125) and interleukin-1 receptor-like 1 (ST2)

Results
88 patients were included (age, 66.8±9.9 years; 93.2% male; 77.3% in NYHA II functional class; 75% treated with loop diuretics). The median of lines B was 2 (RIQ 1–4), 2 (RIQ 1–4) and 2 (RIQ 0–4) at the initial visit, 15 days and 3 months, respectively (initial vs. 3 months, p=0.21) (Table 1). The number of patients treated with loop diuretics decreased from 66 to 33 (p&lt;0.001) and the mean dose of furosemide (or equivalent) in those who continued decreased from 61±5 mg/day to 45.8±20 mg/day (p&lt;0.001). There were no hospitalizations for HF in the 3 months of follow-up. None of the biomarkers showed statistically differences at 3 months of follow-up (Table 1).

Conclusions
The introduction of SGLT2i allowed a significant reduction of diuretics in chronic HF patients and diabetes, without evidence of worsening lung congestion assessed neither by LUS nor by HF biomarkers.

Funding Acknowledgement
Type of funding sources: None.
SGLT2i uptake among heart failure patients with reduced ejection fraction: ongoing prescriber hesitancy and how to address this
Authors: Soh B W T , Balfe C , O Brien K , Glasgow J , Forkin A , Sim W H , Muradagha H , Abbas S , Arnous S , Kiernan T 
Published: October 2022

Abstract

Background
The evidence of mortality benefit from sodium-glucose transport protein 2 inhibitors (SGLT2i) in the management of heart failure with reduced ejection fraction (HFrEF) has been observed since 2019. Its first-line use in HFrEF, regardless of diabetes status, has been recommended by The European Society of Cardiology (ESC) since September 2021. Yet prescriber hesitancy surrounding SGLT2i use is still an under investigated issue resulting in centres falling short of gold-standard care. A simple review of pharmacotherapy pattern can alert clinicians to under prescribing of SGLT2i inhibitors and respond by improving adherence to guidelines.

Purpose
To describe the pharmacotherapy pattern of HFrEF patients attending an outpatient (Heart Failure Support Unit) HFSU in Ireland.

Methods
A retrospective analysis was performed in HFrEF patients actively attending the HFSU. Active attendance was considered a single engagement with the service between 1st January 2021 and 31st December 2021, and patients who have not died, been transferred to another service, or loss to follow-up. Information collected from digital records included patient demographic, comorbidities, baseline investigations, and pharmacotherapy pattern. Sensitivity analysis was performed for patients with type 2 diabetes (T2DM).

Results
156 HFrEF patients were actively attending the HFSU. The mean age was 72.1 (±12.5) years and majority were male 114 (73.1%). The following pharmacotherapy pattern was revealed: angiotensin-converting enzyme inhibitors/ angiotensin II receptor blockers (ACEi/ARBs) 80 (51.3%), ARNi 55 (35.3%), β-blockers 142 (91.0%), mineralocorticoid receptor antagonist (MRA) 58 (37.2%), SGLT2i 9 (5.8%) and Ivabradine 9 (5.8%). Sensitivity analysis for T2DM patients (n=45) reveals a pattern of ACEi/ARBs 46.7%, ARNi 37.8%, β-blockers 95.6%, MRA 42.2%, SGLT2i 20.0% and Ivabradine 8.9%. All 9 instances of SGLT2i use were in T2DM patients. Since identification of SGLT2i under-prescribing, an interim review on 28th February 2022 revealed that total SGLT2i prescription had increased by 19 (211.1%), all of which were outside the T2DM population.

Conclusions
SGLT2i is still under prescribed for HFrEF management and prescriptions have the tendency to be restricted to T2DM patients. Identification of pharmacotherapy pattern can alert clinicians to prescriber hesitancy and increase new SGLT2i prescriptions outside the T2DM population.

Funding Acknowledgement
Type of funding sources: None.