bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of myocardial work in patients recovered from the severe form of COVID-19
Authors: Sousa T L F , Alves M J N N , Melo M D T , Albuquerque A L P , Martins J G , Botelho L F B 
Published: October 2022

Abstract

Background/Introduction
The impact of COVID-19 goes beyond its acute form, and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as Post-Covid or Long-Covid.

Purpose
Assess the late impact on the cardiorespiratory system of patients recovered from severe Covid.

Methods
We performed cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 after at least 60 days of their discharge. Patients and healthy controls were enrolled to perform transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET).

Results
A total of 52 patients and 24 controls were enrolled. The standard TTE parameters (end diastolic diameters, left ventricular ejection fraction, diastolic function and right ventricular systolic function) showed no difference when compared to the control group. When analyzing the myocardial work, there was a higher Wasted MW (GWW): 135 mmHg% vs 84.5 mmHg% (p=0.002), with lower MW Efficiency (GWE): 94 vs. 96 (p=0.003); as well as lower values of global strain: cases = 18.6% vs. 20.1% (p=0.009). No differences were found in the Constructive MW (GWC) and MW Global Index (GWI). In the CPET data we found lower peak values for the VO2: 24 ml/kg/min vs. 32.75 ml/kg/min (p&lt;0.001); for the Heart Rate: 162 bpm vs. 175 bpm (p&lt;0.001); for the Ventilation: 79.3 L/min vs. 109.85 L/min (p&lt;0.001) and Respiratory Exchange Ratio: 1.12 vs. 1.19 (p=0.004). There was no difference in the maximum load reached, neither in the oxygen pulse values and in the Ve/CO2 slope. In relation to the oxygen kinetics, there was a significant reduction in OUES%: 85% vs. 98% (p=0.03); as well as an extended T½: 112 s vs. 88.5 s (p&lt;0.001); and a slowing of the fall in heart rate in recovery time, as measured by the Heart Rate decay: −17.32 bpm vs. −22.08 bpm (p=0.005).

Conclusion
Patients recovered from the severe form of COVID-19 had higher GWW with lower efficiency (GWE). Such findings, added to changes in oxygen kinetics during exercise, may point to a possible cardiocirculatory mechanism associated with decreased aerobic capacity.

Funding Acknowledgement
Type of funding sources: None.
Left ventricular mechanical dispersion by speckle tracking echocardiography is a predictor of atrioventricular block after transcatheter aortic valve implantation
Authors: Kaya E , Andresen K , Lie O H , Aaberge L , Haugaa K , Edvardsen T , Skulstad H 
Published: October 2022

Abstract

Background
Transcatheter Aortic Valve Implantation (TAVI) is an effective therapy for patients with severe aortic stenosis (AS). Complete atrioventricular block (AVB) that requires permanent pacemaker implantation is a common complication of TAVI. Direct mechanical effect of the prosthetic valve, QRS duration and underlying myocardial fibrosis are proposed mechanisms of AVB after TAVI. Left ventricular mechanical dispersion (LVMD) by Speckle Tracking Echocardiography (STE) is an index of contraction heterogeneity and a marker of myocardial fibrosis.

Purpose
We aimed to evaluate the association between LVMD, QRS duration and AVB to assess markers used to predict AVB after TAVI.

Methods
A total of 163 consecutive TAVI patients were enrolled in the study. Echocardiograms andelectrocardiograms were recorded the day before TAVI procedure to assess global longitudinal strain (GLS), LVMD and QRS duration. AVB and pacemaker (PM) implantation information was obtained by telephone interviews three months after TAVI.

Results
Ten patients were excluded due to poor image quality. Of the 153 patients analyzed, 45% were female. Mean age was 80±7 years. In our patient cohort 15.7% of the patients received PM within three months after TAVI. GLS and QRS duration was not different between AVB group and No-AVB group (−15.8±4.5% vs −16.9±4.4%, p=0.26 and 107±31ms vs 102±18ms, p=0.24 respectively). LVMD was prolonged in patients with subsequent AVB compared to patients with No-AVB (60±19ms vs 48±13ms, p&lt;0.001) (Figure 1). LVMD predicted AVB after TAVI with area under the curve 0.71. LVMD predicted AVB independently of QRS duration (odds ratio 1.68; 95% confidence interval 1.23–2.3; p=0.001 by 10ms increments) (Table 1).

Conclusion
LVMD predicted AVB after TAVI independent of QRS duration. LVMD may be of added value as a myocardial functional echocardiographic predictor of this important and frequent complication of TAVI.

Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): EACVI Research Grant 2020
Advanced echocardiography with left atrial strain and indexed left atrial 3D volume for predicting underlying atrial fibrillation after cryptogenic stroke
Authors: Vera Sainz A , Cecconi A , Ximenez Carrillo A , Ramos C , Martinez Vives P , Lopez Melgar B , Sanz Garcia A , Ortega G , Montes A , Aguirre C , Vivancos J , Alfonso F , Jimenez-Borreguero L J 
Published: October 2022

Abstract

Introduction
Cryptogenic stroke (CS) represents one-third of ischemic strokes. Atrial fibrillation (AF) can be detected in up to 30% of CS. Therefore, there is a clinical need for predicting AF to guide the optimal secondary prevention strategy. The evidence about the role of advanced echocardiography, including left atrial 3D index volume and left atrial strain (LAS) techniques, to predict underlying AF in this setting is lacking.

Methods
From April 2019 to November 2021 seventy-eight consecutive patients with ischemic stroke or transient ischemic attack with ABCD2 scale ≥4 of unknown etiology were prospectively recruited. Echocardiography was performed during admission. All patients underwent 15 days wearable Holter monitoring. The primary outcome measure was AF detection during follow-up.

Results
Twenty -two patients (28%) developed AF. Patients in the AF group were older (81±6.3 vs 76.5±7.8 years; p=0.012). Left atrial (LA) diastolic indexed volume was higher in AF group (37.2±12.8 vs 29.7±11 ml/m2 p=0.01). 3D LA indexed volume were also higher in patients with AF (41.4±14 vs 32.2±10 ml/m2 p=0.009). LAS reservoir, LAS conduct and LAS contraction (LASct) were significantly lower in patients with AF (19±5.6 vs 32±10.3%; 9±4.5 vs 15±7.6; 10±5.3 vs 17±6.4, respectively, all p&lt;0.001). On multivariate analysis LASct &lt;13.5% and LA 3D indexed volume &gt;44.5 ml/m2 were independent predictors of AF (OR 10.9 [95% CI 1.09–108.2], p=0.042) (Table 1, Figure 1)

Conclusion
LASct &lt;13.5% and LA 3D indexed volume &gt;44.5 ml/m2 are independent predictors of underlying AF in patients with CS. Our results demonstrate the usefulness of advanced echocardiography in this challenging clinical setting.

Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Spanish Society of Cardiology
Impact of left ventricular ejection fraction on mortality and use of mechanical circulatory support in non-ischaemic cardiogenic shock
Authors: Sundermeyer J , Beer B N , Blankenberg S , Kirchhof P , Luedike P , Mangner N , Nordbeck P , Orban M , Pazdernik M , Proudfoot A , Schulze P C , Tavazzi G , Thiele H , Westermann D , Schrage B 
Published: October 2022

Abstract

Background
Evidence in non-ischaemic cardiogenic shock (CS), especially regarding prognostic markers and use of mechanical circulatory support (MCS), is scarce.

Aim
The aim of this study was to evaluate left ventricular ejection fraction (LVEF) as a prognostic marker as well as a factor to guide the use of MCS in non-ischaemic CS.

Methods
In this international observational study, patients with non-ischaemic CS (e.g. caused by severe de-novo or acute on chronic heart failure; but not by acute myocardial infarction) treated with or without MCS from 18 tertiary-care centers in five countries were enrolled. Cox regression models adjusted for age, sex, SCAI class, lactate, prior resuscitation, mechanical ventilation and pH were fitted to evaluate the association between LVEF and 30-day mortality as well as the interaction between MCS use, LVEF and 30-day mortality.

Results
A total of 807 patients were enrolled, of whom 387 (47,9%) were treated with and 418 (52.1%) without MCS; mean age was 63 [interquartile range (IQR) 51.5–72) years, 601 (74.5%) were male, 486 (60.2%) had acute on chronic heart failure, 221 (32.7%) had an ischaemic cardiomyopathy and 277 (34.5%) had prior cardiac arrest. The baseline LVEF was 20 (IQR 15–30) % and baseline lactate was 4.9 (IQR 2.6–8.5) mmol/l.
There was no significant association between LVEF and 30-day mortality risk [hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.74–1.22 if LVEF was considered as a continuous variable; HR 1.09, 95% CI 0.83–1.44 if LVEF was considered as a categorical variable with ≤20% vs. &gt;20%]. However, there was a significant interaction between MCS use and LVEF, indicating a lower 30-day mortality risk with MCS use in patients with a depressed LVEF (HR 0.74, 95% CI 0.52–1.05, interaction-p = 0.04).

Conclusion
In this retrospective, multicenter, international study of patients with non-ischaemic CS, LVEF was not a predictor of 30-day mortality risk. However, we observed a significant interaction between MCS use and LVEF, indicating a lower morality risk with MCS use only in patients with a depressed LVEF. This provides rationale to use LVEF as a parameter to guide MCS therapy in non-ischaemic CS, and calls for a randomized trial on this topic.

Funding Acknowledgement
Type of funding sources: None.
Impact of primary diagnosis on survival after heart transplant in female recipients of childbearing age: an analysis of the International Society for Heart and Lung Transplantation (ISHLT) Registry
Authors: Macera F , Cherikh W S , De Filippis E M , Ross H , Stehlik J , Bhagra C J 
Published: October 2022

Abstract

Background
Women undergoing heart transplantation (HT) for peripartum cardiomyopathy (PPCM) have been reported to have inferior post-transplant survival. Specific data on the impact of pre-transplant diagnosis on survival in female HT recipients of childbearing age are lacking, but important for pre-conception counseling of women considering a pregnancy.

Methods
Retrospective data analysis was conducted using the ISHLT Registry. The primary aim was to study the impact of pre-transplant diagnosis and alloimmunisation on post-transplant survival in women aged 15–45 yrs at time of HT. Secondary outcomes included the impact of primary diagnosis on conditional survival at 5, 10 and 15-yrs post HT.

Results
Of 121,501 HT recipients (Jan 1992–June 2018), 30,179 (24.8%) were women. 9,229 (7.6%) were 15–45 yrs at time of HT. Peripartum cardiomyopathy (PPCM) and congenital heart diseases (CHD) was the primary diagnosis in 8.9% and 9.3%, respectively. Overall median post-transplant survival was 15.2 yrs. Female with PPCM were associated with higher alloimmunisation (Figure 1). PPCM was associated with lower survival (median survival in PPCM vs CHD vs other: 9.1 years vs 15.2 years vs 15.5 years respectively, p&lt;0.05). This was not entirely explained by higher alloimmunisation in this group (Figure 2A). Five-year conditional survival of recipients of childbearing age was significantly affected by primary diagnosis of PPCM, and by pediatric status at HT, defined as age &lt;18-yrs (PPCM vs other diagnosis p&lt;0.05; pediatric vs non-pediatric p 0.003), whilst 10- and 15-year conditional survival was not. The difference in 5-year conditional outcome between PPCM and other diagnosis, was not significant however when female recipients were grouped according to their level of alloimmunisation (Figure 2B).

Conclusion
PPCM as the primary indication for HT is associated with a worse post HT survival. Our data suggest that this is not entirely explained by alloimmunisation. The impact of previous PPCM appears to be greatest in the first 5 yrs post HT. Further research is needed to fully elucidate the mechanisms associated with worse survival in this group and help inform pre-conception counseling in those HT recipients considering a subsequent pregnancy.

Funding Acknowledgement
Type of funding sources: None.
Intracardiac echocardiography as transesophageal echocardiography replacement in percutaneous intervention imaging: a systematic review and meta-analysis
Authors: Pritazahra A , Hadwiono M R 
Published: October 2022

Abstract

Background
Intracardiac echocardiography (ICE) has become more popular as an alternative to transesophageal echocardiography (TEE), the current gold standard modality of intraoperative imaging in percutaneous closure of interatrial communications, despite the limited three-dimensional capabilities and operational learning curve. ICE's primary strength is the lack of general anaesthesia, thus reducing the risk from airway intervention. Studies have shown that the successful device deployment rate assisted with ICE was similar to TEE. In addition, the optimal use of ICE has been suggested to lower procedural and fluoroscopy time, leading to better outcomes. However, there is currently limited evidence in this area to support ICE as the better option for imaging in percutaneous atrial septal intervention.

Purpose
To compare the total procedural time and fluoroscopy exposure between ICE versus TEE for the guidance of percutaneous atrial septal intervention.

Methods
We performed a comprehensive literature search using PUBMED and Google Scholar from inception to December 2020. Publications that compared ICE and TEE in the atrial septal intervention in adult patients were screened according to our eligibility criteria. The primary outcome of the study was procedural time. Analysis was performed using Revman 5.4.

Results
Five studies were included in this study, providing a total of 332 (ICE=169 VS TEE=163) patients. The mean procedural time was shorter in the ICE group compared to the TEE group (mean differences −8.67 minutes, 95% CI: −10.48 to −6.86, p&lt;0.0001, I2=95%). The mean fluoroscopy exposure was also shorter in the ICE group (mean differences −3.22 minutes, 95% CI: −3.73 to −2.71, p&lt;0.0001, I2=87%). There was no difference in term of success rate of the closure nor significant complications during peri-procedural reported in all studies.

Conclusion
ICE-assisted intervention was shown to be more efficient and associated with statistically significant shorter procedure time and fluoroscopy time than TEE, reducing the possible risk for side effects. Therefore, our analysis suggested that ICE could replace TEE as primary guidance of percutaneous atrial septal intervention.

Funding Acknowledgement
Type of funding sources: None.
Outcomes in hospitalised diabetic ketoacidosis patients with underlying heart failure: a national inpatient sample analysis
Authors: Yalamanchili S , Khdeir O K , Atluri R T 
Published: October 2022

Abstract

Management of diabetic ketoacidosis (DKA) is challenging in patients with heart failure as they tend to be fluid sensitive. We conducted this study to assess the impact of heart failure (HF) on in-hospital outcomes in patients hospitalized with DKA.
We conducted this cohort study using the national inpatient sample database from 2017 and 2018. The International Classification of Diseases-10 codes were used to identify patients with DKA as the principal diagnosis and stratified them based on whether they had HF. The outcomes were in-patient mortality, length of stay, total hospital charges, and complications during the hospitalization. We used multivariate regression analysis to adjust for confounders.
Among the 446,339 total hospitalized for DKA, 20,210 had a secondary diagnosis of HF. The average age was 57 (HF) vs 38 (no HF) (p&lt;0.001). In the HF group, 56% were male and 56% were caucasian. After adjusting for patient demographics, comorbidities, and hospital characteristics, patients with HF had higher odds of cardiogenic shock (aOR=3.77, p&lt;0.001, CI: 1.89–7.49), pneumonia (aOR=1.37, p&lt;0.001, CI: 1.18–1.60), Total hospital charges (coefficient= $5,894.20, p&lt;0.001, CI: 3046–8741) and length of stay (coefficient 0.35 days, p=0.001, CI: 0.14–0.56). There was no statistically significant difference in mortality, cardiac arrest, and sepsis. Patients with HF had lower odds of developing acute kidney injury (aOR=0.66, p&lt;0.001, 0.62–0.72).
Among hospitalized patients with DKA, those with HF had worse outcomes in terms of length of stay, total hospital charges, cardiogenic shock, and pneumonia. However, there was no statistically significant increase in inpatient mortality.

Funding Acknowledgement
Type of funding sources: None.
The predictive role of mean platelet volume to lymphocyte ratio and neutrophil-to-lymphocyte ratio for cardiovascular events in adult patients with acute heart failure
Authors: Angkananard T , Inthanoo T , Sricholwattana S , Rattanajaruskul N , Wongsoasu A , Rungsangmanoon W 
Published: October 2022

Abstract

Introduction
The inflammatory response plays a potential role for the pathogenesis and adverse outcomes of heart failure (HF).

Purpose
We aimed to explore the predictive role of neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume to lymphocyte ratio (MPVLR) on cardiovascular events (CVEs) in patients hospitalized with acute HF.

Methods
A retrospective cohort study was conducted in 321 patients with HF between January 2017 and December 2019. The association between their NLR, MPVLR and combined NLR and MPVLR, and CVEs, HF re-hospitalization, in-hospital death, and a composite outcome were explored by survival analysis using a Cox proportional hazard model. They were separately investigated and compared with the area under the receiver operating characteristics curve (AUC).

Results
Up to the end of the 3-year follow-up, 96 (29.9%) had CVEs, 106 (33.0%) died, 62 (19.3%) were re-hospitalized with HF, and 21 (6.5%) died during admission. The NLR and MPVLR were significantly associated with CVEs (adjusted HR for NLR ≥3.29, 3.11; 95% CI, 1.98–4.89, MPVLR ≥8.57, 2.86; 95% CI, 1.87–4.39), HF readmission (adjusted HR for NLR ≥3.58, 2.70; 95% CI, 1.58–4.61, MPVLR ≥6.43, 2.84; 95% CI,1.59–5.07), in-hospital mortality (adjusted HR for NLR ≥3.29, 9.54; 95% CI, 2.19–41.40, MPVLR ≥8.57, 7.87; 95% CI, 2.56–24.19), and composite outcome (adjusted HR for NLR ≥3.32, 4.76; 95% CI, 3.29–6.89, MPVLR ≥7.07, 3.64; 95% CI, 2.58–5.15). The AUC of NLR and MPVLR for CVEs were 0.67 (95% CI, 0.61–0.72), and 0.63 (95% CI, 0.58–0.69). Combined NLR and MPVLR increased the AUC to 0.77 (95% CI, 0.72–0.83) with statistical significance.

Conclusion
The elevated NLR and MPVLR on admission in patients with acute HF were independently associated with worse CVEs, HF re-hospitalization, in-hospital death, and composite outcomes. These economical biomarkers should be considered in the management and follow-up care of patients with acute HF.

Funding Acknowledgement
Type of funding sources: None.
Relation of lymphopenia to comorbidity burden and its prognostic value in patients with acute decompensated heart failure with preserved left ventricular ejection fraction: a multicentre study
Authors: Tamaki S , Nagai Y , Shutta R , Masuda D , Yamashita S , Seo M , Yamada T , Yano M , Hayashi T , Yasumura Y , Hikoso S , Sotomi Y , Sakata Y 
Published: October 2022

Abstract

Background
Systemic inflammation resulting from comorbidities is postulated to play a central role in the pathophysiology of heart failure (HF) with preserved ejection fraction (HFpEF). Lymphopenia is a common manifestation of systemic inflammation and a prognostic factor in patients with HF. However, the association of lymphopenia with the comorbidity burden is unknown, and its prognostic value in patients with HFpEF admitted due to acute decompensated heart failure (ADHF) also remains elusive.

Purpose
We sought to clarify the relation of lymphopenia with the comorbidity burden, as well as its prognostic value and complementarity with the Get with the Guidelines-Heart Failure (GWTG-HF) risk score in ADHF patients with HFpEF.

Methods
Patients' data were extracted from the Prospective mUlticenteR obServational stUdy of patIenTs with Heart Failure with Preserved Ejection Fraction (PURSUIT-HFpEF), which is a prospective multicentre registry for patients with ADHF with a LVEF ≥50%. We analysed data of patients admitted between June 2016 and December 2020 who survived to discharge. The total lymphocyte count (per μL) and GWTG-HF risk score were obtained on admission, as previously reported. Comorbidity burden was defined as the number of comorbidities from the following: atrial fibrillation, hypertension, diabetes mellitus, coronary artery disease, chronic kidney disease, chronic obstructive pulmonary disease, anaemia, and obesity. The study endpoint was all-cause death.

Results
Over a median follow-up of 417 days, 181 of the 1013 included patients died. The proportion of patients with a total lymphocyte count in the lowest tertile was increasing with the increase in comorbidity burden (Figure 1). In the multivariate Cox analysis, a total lymphocyte count in the intermediate (hazard ratio [HR] 1.55, 95% confidence interval [CI] 1.00–2.41, p=0.0486) and lowest tertile (HR 2.23, 95% CI 1.47–3.38, p=0.0002) was independently associated with all-cause death. There was a significant difference in the all-cause death rate among the groups stratified by total lymphocyte count tertile (Figure 2). The total lymphocyte count had a higher C-statistic value (0.627) for the prediction of all-cause death than the GWTG-HF risk score, and the C-statistic value of the GWTG-HF risk score was improved when the total lymphocyte count was added (0.613 to 0.636, p=0.0260).

Conclusions
Lymphopenia was significantly associated with comorbidity burden. Furthermore, it was a useful marker of poor prognosis in hospitalised patients with acute HFpEF and was shown to be complementary to the contemporary HF prognostic score.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Roche Diagnostics K.K.Fuji Film Toyama Chemical Co. Ltd.