bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dissociation between two-dimensional and three-dimensional echocardiography – clinical implications
Authors: Lyng Lindgren F , Bundgaard Ringgren K , Ascanius Jacobsen P , Tayal B , Hay Kragholm K , Holmark Andersen N , Zaremba T , Biering-Sorensen T , Mogelvang R , Schnohr P , Boje Jensen G , Sogaard P 
Published: October 2022

Abstract

Objectives
To investigate the agreement between two-dimensional (2DE) and three-dimensional echocardiography (3DE) in a general population, along with clinical impact of the differences.

Background
Left ventricular ejection fraction (LVEF) has prognostic value and is used to guide cardiac treatment. The preferred technique is two-dimensional (2D) echo, although three-dimensional (3D) echo is more accurate when compared to MRI. Our study evaluates the agreement between 2D and 3D LVEF and the potential clinical impact of disagreements.

Methods
Study population ware participants from the Copenhagen City Heart Study, who underwent 2DE and 3DE between 2011–2014. Means of difference (MD) were assessed in participant groups with a LVEF below 40%, 40–50%, and above 50%. Age-adjusted Cox proportional hazard ratios (HR) were calculated for all-cause mortality, major adverse cardiovascular event (MACE) and cardiac event of any kind.

Results
In total 2554 participants from the Copenhagen City Heart Study were included. Median age was 58.3 (IQR: 44.2–69.8) years and 1137 (44.5%) were male. Mean LVEF in 2D was 56.6% (95% CI: 56.4–56.9%) and 52.0% (95% CI: 51.7–52.4%) in 3D, p&lt;0.05. MD increased the further LVEF deteriorated: −14.9% (95% CI: −16.0 to −13.9%) (LVEF &lt;40%), −9.3% (95% CI: −9.8 to −8.9%) (LVEF 40–50%) and −1.2% (95% CI: −1.6 to −0.9%) (LVEF ≥50%). 2DE overestimated the LVEF relative to 3D in 1824 (71.4%) instances.
3D LVEF &lt;40% was associated with a HR for all-cause mortality of 2.58 (95% CI: 1.55–4.31, p&lt;0.05), MACE: 1.90 (95% CI: 1.22–2.98, p&lt;0.05) and cardiovascular event: 1.61 (95% CI: 1.04–2.48, p&lt;0.05).
HR for 2D LVEF &lt;40% 0.84 (95% CI: 0.21–3.41, p=0.80) (all-cause), 3.12 (95% CI: 1.64–5.94, p&lt;0.05) (MACE) and 2.68 (95% CI: 1.42–5.09, p&lt;0.05) (cardiovascular event).

Conclusion
With declining LVEF, 2D echo is prone to significantly overestimate LVEF and a 3D LVEF less than 40% is associated with excess all-cause mortality but less with MACE and cardiovascular events when compared to 2D LVEF.

Funding Acknowledgement
Type of funding sources: None.
3D-Echocardiography in the assessment of lead-induced tricuspid regurgitation
Authors: Chango D X , Pelayo M E , Munin M A , Sanchez G A , Raggio I , Garro H , Arevalo M , Carbajales J , Ronderos R 
Published: October 2022

Abstract

Background
Lead-induced tricuspid regurgitation (LITR) is caused by several mechanisms that can be assessed by 3D-Echocardiography (3DE). Its prevalence was not studied to date in the Latin-American series.

Purpose
To determine prevalence and mechanisms of LITR in a series of patients with permanent cardiac devices by 3DE.

Methods
We perform a cross-sectional analysis of 101 patients with permanent cardiac devices as pacemakers or defibrillators. Transthoracic 3DE was obtained on all patients in RV-focused apical views to perform a complete tricuspid valve leaflets, subvalvular apparatus, lead placement and functional assessment to evaluate possible mechanisms of tricuspid regurgitation.

Results
Of a total of 101 patients, lead visualization was possible in 88%. In 59% lead was in commissural position and did not interfere with tricuspid leaflet mobility. Nevertheless, in 41% LITR was observed by several mechanisms. Leaflet impingement was the most prevalent cause in 30,7% causing valve leaflet interference and organic damage. Catheter adherence and/or entrapment to the leaflet or the tricuspid subvalvular apparatus was present in 10.3%. Two patients seem to have leaflet perforation by the catheter as the main mechanism; however, a further assessment was not possible. Patients with LITR had higher time since catheter implantation, lower left ventricular ejection fraction, more severity of tricuspid regurgitation, and right ventricular dilatation.

Conclusions
3DE enables to the identification of 41% of patients with LITR and leaflet impingement was the most prevalent mechanism. LITR patients had more time since cardiac device implantation. Some unfavorable catheter locations on the tricuspid valve can have some influence on the development of LITR over time.

Funding Acknowledgement
Type of funding sources: None.
Lower rate limit in cardiac resynchronization therapy defibrillators
Authors: Barradas M , Duarte F , Coutinho Dos Santos I , Resendes De Oliveira L , Serena C , Xavier Fontes A , Viveiros Monteiro A , Machado C , Dourado R , Santos E , Pelicano N , Pacheco M , Tavares A , Martins D 
Published: October 2022

Abstract

Background
There is few data about programmed lower rate limit (LRL) in real world heart failure (HF) patients with cardiac resynchronization therapy–defibrillators (CRT-Ds) and its influence in clinical outcomes. Heart rate score (HRS) is the percentage of all atrial-paced and sensed events in the single tallest 10 beats/min device histogram bin and may indicate impaired heart rate variability.

Purpose
We hypothesized that higher LRL programming is associated with worse clinical outcomes as arrhythmic events and HF decompensations in chronic HF patients with CRT-Ds.

Methods
LRL was evaluated and HRS was calculated from remote monitoring in 126 HF patients with CRT-D. Primary outcome was defined as HF hospitalizations and related admissions to the emergency department and secondary outcome as number of device therapies, sustained ventricular tachycardia (VT) and ventricular fibrillation (VF).

Results
Mean age was 69,03±10,39 years, 81 (64,3%) were males and mean follow-up was 53,72±46,13 months. Mean left ventricular ejection fraction was 30,31±8,33% and 29 (23,0%) were in NYHA III–IV. HF aetiology was idiopathic in 39 (43,3%), ischemic in 32 (25,4%) and alcoholic cardiomyopathy in 8 (6,3%). Thirty-seven (29,4%) patients had atrial fibrillation and 33 (26,2%) coronary disease. LRL ranged from to 40 to 80 bpm and mean LRL was 52,64±9,64 and mean HRS 49,60±23,17%. Programmed LRL was higher in women (p=0,014), patients with atrial fibrillation (AF) (p=0,012) and coronary disease (p=0,015). Higher LRL correlated with HF hospitalizations and related admissions to the emergency department (ED) (r=0,541, p=0,001), VT or VF episodes (r=0,337, p=0,005) and CRT-D number of therapies (r=0,342, p=0,004) and higher HRS (r=0,547, p&lt;0,05).

Conclusion
Higher LRL programming was associated with higher HRS, HF decompensations with hospitalization or admission to the emergency department, VT or VF episodes and CRT-D therapies in a real world population. More studies are required but lower LRL may be preferred in HF patients.

Funding Acknowledgement
Type of funding sources: None.
Long-term outcome and mortality predictors in patients with extremely enlarged left ventricle end-diastolic diameter undergoing cardiac resynchronization therapy
Authors: Mazurek M , Jedrzejczyk-Patej E , Lenarczyk R , Sokal A , Kotalczyk A , Kowalska W , Gumprecht J , Kowalski O , Kalarus Z 
Published: October 2022

Abstract

Background
Data on efficacy of cardiac resynchronization therapy (CRT) and prognosis of CRT recipients with extremely enlarged left ventricular prior to device implantation are scarce.

Aim
To determine outcome and mortality predictors in patients with heart failure (HF) and extremely increased left ventricle end-diastolic diameter (LVEDD) treated with cardiac resynchronization therapy.

Methods
Study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital, in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]).

Results
The median LVEDD before CRT implantation was 68 mm (56–80). We divided all CRT patients into quartiles as per LVEDD: I &lt;61 mm, II 61–67 mm, III 68–73 mm and IV ≥74 mm. During the median follow-up of 1661 days (10th and 90th percentile: 323–3995) mortality rates for quartiles I–IV were 41.2, 49.6, 55.9 and 68.1%, respectively (P&lt;0.001). The LVEDD ≥74 mm (quartile IV) appeared to be an independent risk factor for death (HR 1.29, 95% CI 1.05–1.6, P=0.02). On multivariable analysis, severe mitral regurgitation (MR; HR 1.54, 95% CI 1.1–2.16, P=0.01) and advanced age (HR 1.02, 95% CI 1.01–1.03, P=0.02) were independent risk factors for death in quartile IV. During observation, mortality rate for quartile IV patients aged &gt;65 years and with severe MR was 90%. Exclusion of subjects with severe MR and aged &gt;65 from quartile IV resulted in similar mortality rate (53.1%) as for patients in lower quartiles.

Conclusions
Mortality rates in CRT recipients with extremely enlarged LVEDD is significantly higher compared to those with LVEDD &lt;74 mm. CRT offer to HF patients with LVEDD ≥74 mm (and in particular those with accompanying severe MR and aged &gt;65 years) should be very carefully assessed and other HF therapies (i.e. left ventricular assist devices) should be considered, as more than 90% of those die within 4 years since CRT implantation.

Funding Acknowledgement
Type of funding sources: None.
The impact of frailty index on long-term outcome in CRT patients
Authors: Kuthi L , Schwertner W , Veres B , Merkel E , Behon A , Masszi R , Kovacs A , Osztheimer I , Molnar L , Zima E , Geller L , Kosztin A , Merkely B 
Published: October 2022

Abstract

Background
Frailty is a complex clinical syndrome associated with ageing and comorbidities resulting from multiple organ impairment by losing homeostatic reserves and increased vulnerability to physiological decompensation. Frailty can be measured by quantifying the “vulnerability status” by the range of comorbidities.

Purpose
We assessed the long-term all-cause mortality based on Frailty Index (FI) among patients who underwent Cardiac Resynchronization Therapy (CRT) implantation.

Methods
We calculated patients' FI individually using 30 clinical parameters from our retrospective single centre large-scale registry. The applied clinical features incorporated patients' medical history, anthropometric-, laboratory and echocardiographic parameters. Based on previous studies, patients with FI ≤0.210 were classified as non-frail, and patients above that value were considered frail. Frail patients were divided into two different subgroups (F1; F2) by a FI increment of 0.100 based on the Rockwood method. Primary endpoint was all-cause mortality, log-rank and Cox multivariate analysis were performed.

Results
Among 1010 included patients, 58 (6%) were considered as Non-frail, while 245 (24%) and 707 (70%) participants were categorized to F1- and F2 groups. Patients in F2 group were older [non-frail 62 years (IQR 57–68) vs. F1 66 years (IQR 57–73) vs. F2 70 years (IQR 63–76); p&lt;0.001], had worse laboratory parameters as higher creatinine, uric acid, lower sodium or hemoglobin levels (p&lt;0.001) and more comorbidities than patients of Non-frail or F1 groups. During the median follow-up time of 4.4 (2.3–6.9) years, 17 (29%) patients in the Non-frail group, 103 (42%) in Frail group 1 and 479 (68%) in the Frail group 2 reached the primary endpoint. Non-frail patients showed the best outcome, and patients in the Frail group 1 demonstrated a 46% (HR 0.46, 95% CI 0.39–0.55; p&lt;0.001) lower all-cause mortality risk compared to Frail group 2. In the total cohort, mortality predictors were also assessed, NYHA functional class, serum sodium, creatinine and TAPSE were identified as independent predictors of all-cause mortality.

Conclusion
By calculating individual frailty index among CRT patients, distinct groups could be identified, of which mortality differed significantly. Those with the highest Frailty index demonstrated the worse outcome compared to lower index or non-frail patients. Frailty index can help selecting the most vulnerable patients, requiring a strict follow-up.

Funding Acknowledgement
Type of funding sources: None.
Artificial intelligence-based body composition predicts postoperative complications and mortality in advanced heart failure patients receiving long-term mechanical circulatory support
Authors: Just-Lauer I A , Schoenrath F , Roehrich L , Auer T A , Fehrenbach U , Potapov E J , Solowjowa N , Balzer F , Geisel D , Braun J , Boening G 
Published: October 2022

Abstract

Background
Obesity is an independent cardiovascular risk factor and is associated with higher postoperative infection rates in patients after cardiac surgery. However, in heart failure, obesity has been described as beneficial in terms of survival (“obesity paradox”); whereas sarcopenia is associated with poor prognosis. An increasing number of advanced heart failure patients requires surgical treatment in terms of left ventricular assist device (LVAD) implantation. The postoperative in-hospital survival has improved in recent years but is still relatively high (11.1%). The impact of body composition on outcome in this population remains unclear.

Purpose
The aim of this investigation was to examine the preoperative computed tomography (CT) body composition based on artificial intelligence (AI) analysis as a predictor of the postoperative outcome in advanced heart failure patients, who underwent LVAD implantation.

Methods
Preoperative CT scans of 137 patients who received LVAD implantations between 2015 and 2020 were retrospectively analyzed using an AI-powered automated software tool based on a convolutional neural network, U-net, developed for image segmentation (Visage version 7.1., Visage Imaging GmbH, Berlin, Germany; Figure 1). Assessment of body composition included visceral and subcutaneous adipose tissue areas (VAT, SAT), psoas and total abdominal muscle areas (PMA, TAMA) and sarcopenia (defined as lumbal skeletal muscle index ≤38.5 cm2/m2 in women and ≤54.4 cm2/m2 in men). The body composition parameters were correlated with postoperative major complication rates and survival.

Results
The mean age of patients was 58.21±11.9 years; 122 (89.1%) were male. Most patients had severe heart failure requiring inotropes (INTERMACS profile I-III, 71.9%) secondary to coronary artery diseases or dilated cardiomyopathy (96.4%). 44 (32.1%) patients were obese (BMI ≥30 kg/m2), 96 (70.1%) were sarcopene and 19 (13.9%) were sarcopene obese. Adipose tissue was associated with a significantly higher risk of overall postoperative complications (SAT 158.22 cm2 [63.09, 256.78 cm2] vs. 124.04 cm2 [42.86, 187.68 cm2], p=0.049) and in-hospital mortality (VAT 168.11 cm2 [134.19, 285.27 cm2] vs. 135.42 cm2 [49.44, 227.91 cm2], p=0.033; SAT 227.28 cm2 [139.38, 304.35 cm2] vs. 173.81 cm2 [97.65, 254.16 cm2], p=0.009). Sarcopenia did not influence the postoperative outcome and survival within 1 year post LVAD implantation.

Conclusions
Preoperative AI-based CT body composition identifies patients with poor prognosis after LVAD implantation. Adipose tissue areas predict in-hospital mortality, thus, obesity as a perioperative risk factor outweighs the protective effect known in heart failure patients when undergoing LVAD implantation.

Funding Acknowledgement
Type of funding sources: None.
Right ventricular myocardial work in patients undergoing left ventricular assist device implant
Authors: Mandoli G E , Landra F , Pica A , Marrese F , Gallone G , Sciaccaluga C , Cavigli L , D'Ascenzi F , Focardi M , Maccherini M , Bernazzali S , Valente S , Cameli M 
Published: October 2022

Abstract

Background
Right ventricular failure (RVF) complicates 10 to 40% of left ventricular assist device (LVAD) implants, with necessity of high dose inotropic/vasodilatory drugs and right ventricular assist devices in severe cases. Prevention of RVF starts with appropriate patient selection for LVAD implant through extensive clinical, echocardiographic and hemodynamic evaluation.

Purpose
This study aimed to evaluate the performance of a novel non-invasive echocardiographic method for estimation of right ventricular myocardial work to predict RVF and death after LVAD implant.

Methods
Consecutive patients from May 2017 to February 2022 undergoing LVAD implant were retrospectively reviewed. Patients without a useful echocardiographic exam and/or a right heart catheterization prior to LVAD implant were excluded. Myocardial work analysis by Speckle Tracking Echocardiography (STE) was performed in these patients. The primary endpoints were RVF and death.

Results
The study included 23 patients (mean age 64±8 years, 91% men). Median follow-up time was 304 days (IQR: 23–1017). GWI significantly correlated with invasively-derived right ventricular stroke work index (RVSWI, r=0.538; p=0.008) and pulmonary arterial compliance (PAC, r=−0.522; p=0.013). Patients who experienced RVF (26.1%) had lower GWI (p=0.047) and GWE (p=0.001) and higher GWW (p=0.001). Patients who experienced death at 30 days after LVAD implant (26.1%) had lower GWE (p=0.005) and higher GWW (p=0.006). Performance for prediction of RVF after LVAD implant was greatest for GWE (AUC 0.92), followed by GWW (AUC 0.88) and GWI (AUC 0.78). A cut-off of 77% for GWE have a 100% sensibility and 82% specificity for prediction of RVF. At long term follow-up, death occurred in 4 patients (29%) in the GWE&gt;77% group and in 6 patients (67%) in the GWE&lt;77% group (hazard ratio for death, 0.24; 95% CI, 0.07 to 0.89, p=0.032).

Conclusions
Right ventricular myocardial work is a strong predictor of RVF after LVAD implant and death at long-term follow up. Its calculation should be implemented in the evaluation for LVAD candidacy.

Funding Acknowledgement
Type of funding sources: None.
Impact of preoperative hemodynamic optimization on right ventricular failure after left ventricular assist device implantation
Authors: Briasoulis A , Alvarez P , Panos A , Ruiz Duque E 
Published: October 2022

Abstract

Background
Preoperative hemodynamic parameters are linked to higher rates of right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. It is unclear if preoperative hemodynamic optimization decreases the incidence of RVF after LVAD.

Methods
Single-center retrospective analysis of consecutive LVAD recipients between 2015 and 2020. Pre-operative right heart catheterization and a strategy of hemodynamic optimization were performed in all patients. Pre-operative right ventricular dysfunction (RVD) was defined by a CVP ≥16 mmHg and pulmonary artery pulsatility index (PAPi) &lt;1.85. The optimization goal was defined as CVP &lt;16 mmHg, PAPi ≥1.85, and Cardiac Index of ≥2.0. The main outcome was RVF (inotropes &gt;14 days, discharge on home inotropes, or right ventricular mechanical support device).

Results
128 LVAD recipients (age 58 years, 74% male, 68% had non-ischemic cardiomyopathy, 45% were on home inotropes, HeartMate 2 in 61%, HeartMate 3 in 31%, and HVAD in 9%) were analyzed. Pre-operative RV dysfunction was present in 48% and these patients were younger, with higher rates of home inotropes, and intra-aortic balloon pump (IABP) pre-LVAD. Postoperative RVF occurred in 60% of patients with RV dysfunction and 40% of the patients without pre-operative RV dysfunction (p&lt;0.002). 40% of patients with RV dysfunction achieved RV optimization goals (32% required IABP). Among those, 53% developed RVF-Post LVAD. RVF was numerically but not significantly higher among those with RV dysfunction who achieved hemodynamic goals (66% vs. 34%, p=0.37) vs. those that did not. Patients with RVF-post LVAD had 10% (n=5) in-hospital mortality.

Conclusion
Pre-LVAD RV dysfunction based on hemodynamic markers is associated with RVF after LVAD implantation. In patients with RV dysfunction, a strategy of pre-LVAD “optimization” to achieve RV hemodynamic optimization goals did not affect the incidence of post-operative RVF.

Funding Acknowledgement
Type of funding sources: None.
Characteristics and outcomes of left ventricular assist device recipients transplanted before and after the new donor heart allocation system
Authors: Briasoulis A , Inampudi C , Kourek C , Asleh R , Doulamis I 
Published: October 2022

Abstract

Background
Concerns about the impact of the new donor heart allocation system on post-transplant outcomes have emerged after its implementation. We sought to evaluate the characteristics and outcomes of left ventricular assist device (LVAD) recipients transplanted before and after the implantation of the new policy on October 18, 2018.

Methods
Data on bridge to transplantation adult LVAD patients January 2015 and October 2021, with durable LVAD as a (BTT), was queried from the United Network of Organ Sharing (UNOS) registry. The main outcomes were 30-day all-cause mortality, 30-day fatal graft failure, 1-year all-cause mortality, treated acute rejection at one year and renal replacement therapy (RRT) for acute renal failure.

Results
In our study, 7096 patients met the inclusion criteria including 2,435 in the new allocation system. The transplanted patients in the new allocation system era had older donor age, longer ischemic time and higher proportion of newer generation LVADs. Adjusted 30-day all-cause mortality was significantly lower for LVAD recipients in the new allocation system era (sub-hazard ratio [SHR] 0.36, 95% Confidence intervals [CI] 0.27–0.48, p&lt;0.001) without differences in the risk of fatal graft failure and one-year mortality. Significantly lower adjusted 30-day mortality with HVAD and HM3 devices than HM2 in the new allocation system era was found, without differences in one-year mortality. Acute allograft rejection requiring treatment was significantly lower (Odds Ratio 0.78, 95% CI 0.65–0.94, p=0.01) whereas a trend towards higher risk of renal failure requiring RRT was identified.

Conclusions
Despite changing donor characteristics and longer ischemic times, post-transplant outcomes in LVAD recipients have not worsened with the implementation of the new allocation system and this finding is related to the use of newer generation continuous flow LVADs.

Funding Acknowledgement
Type of funding sources: None.
Characteristics, predictors and outcomes of early mTOR inhibitor use after heart transplantation: insights from the UNOS database
Authors: Briasoulis A , Doulamis I , Kampaktsis P 
Published: October 2022

Abstract

Background
The clinical characteristics of mammalian target of rapamycin (mTOR) inhibitors use in heart transplant (HT) recipients and their outcomes have not been well described.

Methods
We compared patients that received mTOR inhibitors within the first 2 years after HT to patients that did not by inquiring the United Network for Organ Sharing database between 2010 and 2018. The primary endpoint was all-cause mortality with re-transplantation as a competing event. Rejection, malignancy, hospitalization for infection and renal transplantation were secondary endpoints.

Results
There were 1,619 (9%) and 15,686 (81%) mTORi+ and mTORi− patients respectively. Body mass index, induction, cardiac allograft vasculopathy, calculated panel reactive antibody and less days in 1A status were independently associated with mTORi+ status. Over a follow up of 10.4 years there was no difference in all cause mortality after adjusting for donor and recipient characteristics (adjusted subdistribution hazard ratio 1.03 [0.90–1.19], p=0.66) (Figure 2). mTORi+ was independently associated with increased risk for rejection (odds ratio 1.43 [1.11–1.83], p=0.005) but not for infection, malignancy or renal transplantation.

Conclusion
mTOR inhibitors are used in &lt;10% patients in the first 2 years after HT and are non-inferior to contemporary immunosuppression regimens in terms of all-cause mortality, infection, malignancy or renal transplantation. They are associated with risk for rejection.

Funding Acknowledgement
Type of funding sources: None.