Large Language Models with Novel Token Processing Architecture: A Study of the Dynamic Sequential Transformer

Kusi Men, Na Pin, Shumei Lu, Qian Zhang, Huanhuan Wang

Abstract: The increasing complexity and scale of language models have introduced significant challenges related to computational efficiency, inference speed, and the generation of factually accurate responses. Addressing these issues, a novel architectural enhancement known as the Dynamic Sequential Transformer (DST) has been proposed, offering a groundbreaking approach to token processing through dynamic token sequencing and adaptive attention recalibration. By introducing a more flexible and context-aware method for handling tokenized inputs, DST improves both accuracy and speed while reducing the occurrence of hallucinations, which are a common problem in language generation tasks. The experimental results have demonstrated that the DST architecture significantly reduces memory usage, accelerates inference times, and improves model convergence rates, making it an efficient solution for large-scale deployments without sacrificing output quality. Additionally, DST's modular design ensures scalability and robustness across diverse language processing tasks, positioning it as a promising advancement for practical real-world applications. Through extensive evaluation, the study confirms that DST not only optimizes resource utilization but also enhances the linguistic coherence and factual consistency of generated text, establishing a new benchmark for architectural efficiency in modern language models.


Deep Learning Transformer Architecture

Artificial Intelligence and Large Language Models

Kutub Thakur, Helen G. Barker, Al-Sakib Khan Pathan


Construction of Collaborative Intelligent Manufacturing Agents For Special Transformer Coil Workshop Based on Large Language Models And Digital Twins

Xuedong Zhang, Wenlei Sun, Ke Chen, Renben Jiang


Large Language Models for Quality Control of Large Language Models

SCITEPRESS - Science and Technology Publications

Proceedings of the 14th International Conference on Model-Based Software and Systems Engineering

Preethika Chandrasekaran, Imron Shajahan, Saran Sankaran, Benjamin Nast, Kurt Sandkuhl

Institute of Computer Science, University of Rostock, Albert-Einstein-Str. 22, 18059 Rostock, Germany


On the Interpretability of Transformer Based Large Language Models

2025 2nd International Conference on Advanced Computing and Emerging Technologies (ACET)

Meerut institute of engineering and technology,Computer Science and Engineering,Meerut,India


Transparent AI for mathematics: transformer-based large language models for mathematical entity relationship extraction with XAI


Large Language Models


Database-Augmented Transformer-Based Large Language Models Achieve High Accuracy in Mapping Gene-Phenotype Relationships

Nicolas Matthew Suhardi, Anastasia Oktarina, Mathias P.G. Bostrom, Xu Yang, Vincentius Jeremy Suhardi

Skeletal Health and Orthopedic Research Program, Hospital for Special Surgery, New York, NY 10021, USA

Abstract: Abstract Transformer-based large language models (LLMs) have demonstrated significant potential in the biological and medical fields due to their ability to effectively learn from large-scale, diverse datasets and perform a wide range of downstream tasks. However, LLMs are limited by issues such as information processing inaccuracies and data confabulation, which hinder their utility for literature searches and other tasks requiring accurate and comprehensive extraction of information from extensive scientific literature. In this study, we evaluated the performance of various LLMs in accurately retrieving peer-reviewed literature and mapping correlations between 102 genes and four phenotypes: bone formation, cartilage formation, fibrosis, and cell proliferation. Our analysis included standard transformer-based LLMs (ChatGPT4o and Gemini1.5 Pro), fine-tuned LLMs with dedicated custom databases containing peer-reviewed articles (SciSpace and ScholarAI), and fine-tuned LLMs without dedicated databases (PubMedGPT and ScholarGPT). Using human-curated gene-to-phenotype mappings as the ground truth, we found that fine-tuned LLMs with dedicated databases (SciSpace and ScholarAI) achieved high accuracy (>80%) in gene-to-phenotype mapping. Additionally, these models were able to provide relevant peer-reviewed publications supporting each gene-to-phenotype correlation. These findings underscore the importance of database augmentation and finetuning in enhancing the reliability and utility of LLMs for biomedical research applications.


The Mathematics of Large Language Diffusion Models versus Large Language Autoregressive Models


Evaluating Models


Large Language Models Projects


Improving Narrative Coherence in Dense Video Captioning through Transformer and Large Language Models

Department of Computer Science and Engineering, Institute of Technology, Nirma University, Ahmedabad

Abstract: Dense video captioning aims to identify events within a video and generate natural language descriptions for each event. Most existing approaches adhere to a two-stage framework consisting of an event proposal module and a caption generation module. Previous methodologies have predominantly employed convolutional neural networks and sequential models to describe individual events in isolation. However, these methods limit the influence of neighboring events when generating captions for a specific segment, often resulting in descriptions that lack coherence with the broader storyline of the video. To address this limitation, we propose a captioning module that leverages both Transformer architecture and a Large Language Model (LLM). A convolutional and LSTM-based proposal module is used to detect and localize events within the video. An encoder-decoder-based Transformer model generates an initial caption for each proposed event. Additionally, we introduce a Large Language Model (LLM) that takes the set of individually generated event captions as input and produces a coherent, multi-sentence summary. This summary captures cross-event dependencies and provides a contextually unified and narratively rich description of the entire video. Extensive experiments on the ActivityNet dataset demonstrate that the proposed model, Transformer-LLM based Dense Video Captioning (TL-DVC), achieves a 9.22% improvement over state-of-the-art models, increasing the Meteor score from 11.28 to 12.32.


Evolution and Significance of Large Language Models

Introduction to Python and Large Language Models


20.5 C-Transformer: A 2.6-18.1μJ/Token Homogeneous DNN-Transformer/Spiking-Transformer Processor with Big-Little Network and Implicit Weight Generation for Large Language Models

2024 IEEE International Solid-State Circuits Conference (ISSCC)

Sangyeob Kim, Sangjin Kim, Wooyoung Jo, Soyeon Kim, Seongyon Hong, Hoi-Jun Yoo

Korea Advanced Institute of Science and Technology,Daejeon,Korea


Research and Application of Large Language Models in HealthcareCurrent Development of Large Language Models in the Healthcare FieldA Framework for Applying Large Language Models and the Opportunities and Challenges of Large Language Models in Healthcare: A Framework for Applying Large Language Models and the Opportunities and Challenges of Large Language Models in Healthcare

Proceedings of the 2023 4th International Symposium on Artificial Intelligence for Medicine Science

Chunfang Zhou, Qingyue Gong, Jinyang Zhu, Huidan Luan

School of Artificial Intelligence and Information Technology, Nanjing University of Chinese Medicine, China


Symbolic Constraint-Solving Capabilities of Transformer Large Language Models

Leyan Pan, Chris Esposo, Jacob Abernethy, Vijay Ganesh, Wenke Lee

Technology Innovation Institute (TII) - Abu Dhabi

Abstract: Abstract The empirical success of Transformer-based Large Language Models (LLMs) has elicited significant interest in their application for security domains such as formal verification and program analysis. However, their application in formal domains, such as formal verification and program analysis, is constrained by the lack of mechanical understanding and the risk of hallucinations. To address these challenges, we present a robust theoretical construction establishing that transformer-LLMs with CoT can solve an NP-Hard logical reasoning problem, specifically 3-SAT. Our construction provides theoretical guarantees that these models can either simulate the deductive search processes of SAT-solving or probabilistically generate correct solutions as the most likely completion. Empirically, we demonstrate that transformers can generalize these procedures across different formula distributions, reinforcing their potential for reliable formal reasoning.


Large Language Models in Chemistry


“The Third Man” in Heart Failure – Heart Failure With Reduce Ejection Fraction Evolved From Heart Failure With Preserved Ejection Fraction –

Division of Cardiovascular Medicine, Endocrinology and Metabolism, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University


Statins Beneficial for Heart Failure With Preserved Ejection Fraction But Not Heart Failure With Reduced Ejection Fraction?

Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences


Abstract 13703: Outpatient Cardiac Rehabilitation Reduces Heart Failure Re-Hospitalization in Patient With Heart Failure With Reduced Ejection Fraction When Compared to Patients With Heart Failure With Preserved Ejection Fraction

Ovid Technologies (Wolters Kluwer Health)

KELECHI EMMANUEL, Halimat Lawal, Guillermo Valenzuela, Yijin Wert

Internal Medicine, UPMC Harrisburg, Harrisburg, PA

Abstract: Introduction: Cardiac rehabilitation has been increasingly recognized as an integral part in the management of patients with congestive heart failure. It has been shown to improve the quality of life in this patient population. However, It is unknown how much cardiac rehabilitation reduces heart failure hospitalizations in patients with heart failure with reduced ejection fraction (HFrEF) versus heart failure with preserved ejection fraction (HFpEF). Hypothesis: We hypothesize that outpatient cardiac rehabilitation is associated with reduced re-hospitalization for heart failure symptoms in patients with heart failure with HFrEF when compared with patients with HFpEF. Methods: We retrospectively analyzed data from 128 heart failure patients enrolled in an outpatient cardiac rehabilitation center from January 2015 to December 2020. The number of heart failure re-hospitalizations was measured in each of these patients. A Student t-test was used to analyze the difference between the two groups, while fisher’s test or chi square was used to analyze categorical variables. Results: Among the 128 patients enrolled in the outpatient cardiac rehabilitation center, age 68.1+-14 years, 63 (57.1%) were males. There were 70 patients (54.6%) in the HFrEF group and 58 (55.28%) in the HFpEF group. Hospitalization for acute exacerbation of heart failure symptoms was lower in the patients with HFrEF when compared with patients with HFpEF (41.3% vs 70.69% p value <0.0009). Conclusion: Outpatient cardiac rehabilitation program is associated with reduced hospitalization for heart failure symptoms in patients with HFrEF when compared to patients with HFpEF.


Abstract P1084: Association of Body Composition and Incident Heart Failure and Heart Failure with Preserved Ejection Fraction and Heart Failure with Reduced Ejection Fraction in postmenopausal women

Charles Eaton, mir mad madani, Connor Miller, Andrew Odegaard, Michael LaMonte

Charles Eaton, Plymouth, Massachusetts, United States

Abstract: Background: As the US population ages, Heart Failure (HF) is reaching epidemic proportions, with heart failure with preserved ejection fraction (HFpEF) placing a particular burden on elderly women. While the association of obesity with the risk of heart failure is well established, the role of visceral adiposity and other measures of body composition have had limited research. Methods: A cohort of 10,527 postmenopausal women, mean age 63.3 (7.4) at baseline had DXA measures of VAT area ( cm 2 ), SAT area (cm 2 ), VAT/SAT ratio, Fat mass(kg), Lean mass (kg), % body fat and BMI (kg/m 2 ) and were followed for 16.7 years with 852 cases of incident HF . A sub-cohort of 3528 women were followed for the same period were evaluated for adjudicated HFpEF and HFrEF with 116 cases of HFpEF and 107 cases of HFrEF. We evaluate the association of the above body composition variables using multiple variable cox proportional hazards models (see tables below) .We also evaluated a comprehensive model including all sociodemographic and lifestyle variables as well as potential confounders/mediators of medical co-morbidities. Results: Both quartile and continuous measures of VAT, SAT, VAT/SAT ratio, Fat mass, lean mass, and BMI were associated with increased risk of HF and HFpEF with stronger associations with HFpEF but not HFrEF in our main model. The comprehensive model including potential mediators showed persistent but diminished associations for VAT, VAT/SAT ratio, Fat mass, Lean mass, and BMI but not SAT or %body fat. Time varying measures of VAT, VAT/SAT ratio showed persistent and stronger associations than baseline measures for HF and HFpEF but not HFrEF. Competing risk models for death and HF subtype when evaluating HFpEF or HFrEF showed similar but slightly attenuated results. Conclusion: Visceral Fat and VAT/SAT ratio, Fat mass, and Lean mass are associated with increased risk of HF and HFpEF but not HFrEF in this cohort of elderly women. Whether new treatments for weight loss that reduce visceral fat will reduce the risk of HF and HFpEF is worthy of future research.


Letter by Nunez et al Regarding Article, “Longitudinal Changes in Ejection Fraction in Heart Failure Patients With Preserved and Reduced Ejection Fraction”

Eduardo Nunez, Juan Sanchis, Julio Nunez

Servicio de CardiologíaHospital Clínico Universitario, INCLIVAUniversitat de ValenciaValencia, Spain


Changes in Left Ventricular Ejection Fraction Predict Survival and Hospitalization in Heart Failure With Reduced Ejection Fraction

Khadijah Breathett, Larry A. Allen, James Udelson, Gordon Davis, Michael Bristow

From the Division of Cardiology, University of Colorado, Aurora (K.B., L.A.A., M.B.); Division of Cardiology, Tufts Medical Center, Boston, MA (J.U.); and ARCA Biopharma, Westminster, CO (G.D., M.B.).

Abstract: Background— Left ventricular remodeling, as commonly measured by left ventricular ejection fraction (LVEF), is associated with clinical outcomes. Although change in LVEF over time should reflect response to therapy and clinical course, serial measurement of LVEF is inconsistently performed in observational settings, and the incremental prognostic value of change in LVEF has not been well characterized. Methods and Results— The β-Blocker Evaluation of Survival Trial measured LVEF by radionuclide ventriculography at baseline and at 3 and 12 months after randomization. We built a series of multivariable models with 16 clinical parameters plus change in LVEF for predicting 4 major clinical end points, including the trial’s primary end point of all-cause mortality. Among 2484 patients with at least 1 follow-up LVEF, change in LVEF was the second most significant predictor (behind baseline creatinine) of all-cause mortality (adjusted hazard ratio for improvement in LVEF by ≥5 U responder versus nonresponder [95% confidence intervals] for all-cause mortality=0.62 [0.52–0.73]). Other end points, including heart failure hospitalization or the composite of all-cause mortality and heart failure hospitalization, yielded similar results. LVEF change ≥5 U was associated with a modest increase in discrimination when added to traditional predictors and was predictive of outcomes in both the bucindolol and placebo treatment groups. LVEF change as a predictor of outcomes was affected by sex and race, with evidence that LVEF improvement is associated with less survival benefit in African Americans and women. Conclusions— Serial evaluation for LVEF change predicts both survival and heart failure hospitalization and provides a dynamic/real-time measure of prognosis in heart failure with reduced LVEF. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00000560.


Abstract 9704: Mortality and Readmissions in Patients With Heart Failure With Preserved Ejection Fraction versus Heart Failure With Reduced Ejection Fraction

Yaser Carcora, Amy Gravely, Venkatakrishna N Tholakanahalli, Selcuk Adabag

Dept of Cardiology, Univ of Minnesota, Minneapolis, MN

Abstract: Introduction: Heart failure (HF) is a large public health problem with a 12 month mortality rate of 22% and a 30 day standardized readmission rate of 23%. We aimed to determine the differences in readmissions and long-term survival in patients with Heart Failure with Preserved Ejection Fraction (HFpEF) compared to Heart Failure with Reduced Ejection Fraction (HFrEF). Hypothesis: Heart Failure patients will have high mortality regardless of ejection fraction, with similar readmission rates across groups. Methods: We studied 3200 consecutive patients discharged from the hospital with a primary diagnosis of HF from October 2015 to March 2019. Patients were classified as HFpEF (EF >50%) or HFrEF (EF<50%). Results: At baseline, patients had a mean age of 75.0±10.3 and 97.9% were male. Patients with HFrEF were more likely to have coronary artery disease, myocardial infraction, diabetes, and more likely to be on beta blockers and ACE inhibitors (all p<0.0001)(Table 1). Over 11.2±11.3 months of follow-up, patients with HFrEF were more likely to be readmitted (49.2 vs 37.5%, p<0.0001)(Table 2). However, 3-year cumulative all cause death was no different between groups (34.6% vs. 34%; p=0.512) (Figure). Conclusions: Patients with HFrEF were more likely to have readmissions than those with HFpEF. But the long-term mortality was unacceptably high in both groups.


Longitudinal Changes in Ejection Fraction in Heart Failure Patients With Preserved and Reduced Ejection Fraction

Shannon M. Dunlay, Véronique L. Roger, Susan A. Weston, Ruoxiang Jiang, Margaret M. Redfield

From the Division of Cardiovascular Diseases in the Department of Internal Medicine (S.M.D., V.L.R., M.M.R.), and Department of Health Sciences Research (V.L.R., S.A.W., R.J.), Mayo Clinic, Rochester, Minnesota.

Abstract: Background— Heart failure (HF) can occur in patients with preserved (HFpEF, EF≥50%) or reduced (HFrEF, EF<50%) ejection fraction (EF), but changes in EF after HF diagnosis are not well described. Methods and Results— Among a community cohort of incident HF patients diagnosed from 1984 to 2009 in Olmsted County, Minnesota, we obtained all EFs assessed by echocardiography from initial HF diagnosis until death or last follow-up through March 2010. Mixed effects models fit a unique linear regression line for each person using serial EF data. Compiled results allowed estimates of the change in EF over time in HFpEF and HFrEF. Among 1233 HF patients (48.3% male, mean age 75.0 years, mean follow-up 5.1 years), 559 (45.3%) had HFpEF at diagnosis. In HFpEF, on average, EF decreased by 5.8% over 5 years ( P <0.001) with greater declines in older individuals and those with coronary disease. Conversely, EF increased in HFrEF (average increase 6.9% over 5 years, P <0.001). Greater increases were noted in women, younger patients, individuals without coronary disease, and those treated with evidence-based medications. Overall, 39% of HFpEF patients had an EF<50% and 39% of HFrEF patients had an EF≥50% at some point after diagnosis. Decreases in EF over time were associated with reduced survival whereas increases in EF were associated with improved survival. Conclusions— These data suggest that progressive contractile dysfunction may contribute to the pathophysiology of HFpEF. Prospective longitudinal studies are needed to confirm these observations and establish the mechanism and clinical relevance of decline in EF over time in HFpEF.


Heart Failure and Midrange Ejection Fraction

Wilson Nadruz, Erin West, Mário Santos, Hicham Skali, John D. Groarke, Daniel E. Forman, Amil M. Shah

From the Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Boston, MA (W.N., E.W., H.S., J.D.G., A.M.S.); Department of Internal Medicine, University of Campinas, Campinas, Brazil (W.N.); Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of University of Porto, Porto, Portugal (M.S.); and Department of Medicine, Section of Geriatric Cardiology, University of Pittsburgh Medical Center, PA (D.E.F.).

Abstract: Background— Evidence-based therapies for heart failure (HF) differ significantly according to left ventricular ejection fraction (LVEF). However, few data are available on the phenotype and prognosis of patients with HF with midrange LVEF of 40% to 55%, and the impact of recovered systolic function on the clinical features, functional capacity, and outcomes of this population is not known. Methods and Results— We studied 944 patients with HF who underwent clinically indicated cardiopulmonary exercise testing. The study population was categorized according to LVEF as follows: HF with reduced LVEF (HFrEF; LVEF<40%; n=620); HF with midrange ejection fraction and no recovered ejection fraction (LVEF was consistent between 40% and 55%; n=107); HF with recovered midrange ejection fraction (LVEF, 40%–55% but previous LVEF<40%; n=170); and HF with preserved LVEF (HFpEF; LVEF>55%; n=47). HF with midrange ejection fraction and no recovered ejection fraction and HF with recovered midrange ejection fraction had similar clinical characteristics, which were intermediate between those of HFrEF and HFpEF, and comparable values of predicted peak oxygen consumption and minute-ventilation/carbon dioxide production slope, which were better than HFrEF and similar to HFpEF. After a median of 4.4 (2.9–5.7) years, there were 253 composite events (death, left ventricular assistant device implantation, or transplantation). In multivariable Cox-regression analysis, HF with recovered midrange ejection fraction had lower risk of composite events than HFrEF (hazard ratio, 0.25; 95% confidence interval, 0.13–0.47) and HF with midrange ejection fraction and no recovered ejection fraction (hazard ratio, 0.31; 95% confidence interval, 0.15–0.67), and similar prognosis when compared with HFpEF. In contrast, HF with midrange ejection fraction and no recovered ejection fraction tended to show intermediate risk of outcomes in comparison with HFpEF and HFrEF, albeit not reaching statistical significance in fully adjusted analyses. Conclusions— Patients with HF with midrange LVEF demonstrate a distinct clinical profile from HFpEF and HFrEF patients, with objective measures of functional capacity similar to HFpEF. Within the midrange LVEF HF population, recovered systolic function is a marker of more favorable prognosis.


Response to Letter Regarding Article, “Longitudinal Changes in Ejection Fraction in Heart Failure Patients With Preserved and Reduced Ejection Fraction”

Division of Cardiovascular DiseasesDepartment of Internal MedicineMayo ClinicRochester, MN


Abstract MP031: Prospective Association of Obstructive Sleep Apnea Risk Factors with Heart Failure with Preserved Ejection Fraction and Not Heart Failure with Reduced Ejection Fraction in Postmenopausal Women

Patrick Koo, Umama Gorsi, Mary Roberts, Charles Eaton

Erlanger Health System, Univ of Tennessee College of Medicine Chattanooga, Chattanooga, TN

Abstract: Background: The relationship between obstructive sleep apnea (OSA) and heart failure (HF) has been under-researched especially in postmenopausal women. We therefore evaluated relationship between OSA risk factors and HFpEF and HFrEF in post-menopausal women. Methods: We performed a prospective analysis of a subset of participants who had adjudicated heart failure outcomes (n=42,362) in the Women Health Initiative Observational, Clinical Trial, and Extension Studies (1998-Present). The cohort was followed over an average of 13.4 years. Inverse probability weighting was employed to account for potential selection bias. Cox proportional hazards regression was used to examine the association between OSA risk factors and time to first hospitalized HF. Type of heart failure was determined using the ejection fraction (EF) obtained from 2D echocardiography. EF of ≥45% was categorized as HFpEF, and EF of < 45% was categorized as HFrEF. Models were adjusted for age, race/ethnicity, education, income, marital status, systolic blood pressure, waist-to-hip ratio, diabetes, coronary heart disease, atrial fibrillation, use of hormone replacement therapy, use of sleep medications, modified Charlson comorbidity index, smoking, alcohol consumption, physical activity, and hysterectomy. We also created an OSA summary score (obesity, snoring, poor sleep quality, sleep fragmentation, daytime sleepiness, and hypertension) based on the Berlin questionnaire, which reliably predicts OSA, to examine its relationship with HF. Results: Of the 42,362 women, 1,054 (2.49%) had preserved EF, and 631 (1.49%) had reduced EF. Four of the 6 risk factors (obesity (HR=1.51, 95% CI 1.29-1.76), snoring (HR=1.23, 95% CI 1.04-1.45), sleep fragmentation (HR=1.15, 95% CI 1.01-1.31), and hypertension (HR=1.46, 95% CI 1.31-1.62)) were associated HFpEF after adjusting for confounders. Each additional OSA risk factor in an OSA summary score compared to no risk factors significantly increased the risk of HFpEF in a dose-response fashion (HR=1.36, 1.61, 2.01, 1.97, 2.02, and 2.74 for scores of 1-6, respectively; P trend <0.001) and not HFrEF (P trend =0.26). Only hypertension was associated with HFrEF (HR=1.39, 95% CI 1.22-1.60). Conclusion: Having more OSA risk factors increases the risk of HFpEF but not HFrEF in postmenopausal women. Early recognition and management of OSA risk factors may play an important role in reducing risk of HFpEF in this population.


Right Heart Phenotype in Heart Failure With Preserved Ejection Fraction

Department of Biological Sciences, University of Milano, Italy (M.G.).

Abstract: The health burden of heart failure with preserved ejection fraction is increasingly recognized. Despite improvements in diagnostic algorithms and established knowledge on the clinical trajectory, effective treatment options for heart failure with preserved ejection fraction remain limited, mainly because of the high mechanistic heterogeneity. Diagnostic scores, big data, and phenomapping categorization are proposed as key steps needed for progress. In the meantime, advancements in imaging techniques combined to high-fidelity pressure signaling analysis have uncovered right ventricular dysfunction as a mediator of heart failure with preserved ejection fraction progression and as major independent determinant of poor outcome. This review summarizes the current understanding of the pathophysiology of right ventricular dysfunction in heart failure with preserved ejection fraction covering the different right heart phenotypes and offering perspectives on new treatments targeting the right ventricle in its function and geometry.


Prognostic Impact of Myocardial Interstitial Fibrosis in Non-Ischemic Heart Failure - Comparison Between Preserved and Reduced Ejection Fraction Heart Failure -

Tatsuo Aoki, Yoshihiro Fukumoto, Koichiro Sugimura, Minako Oikawa, Kimio Satoh, Makoto Nakano, Masaharu Nakayama, Hiroaki Shimokawa

Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine


Correction to: Sex-Related Differences in Heart Failure With Preserved Ejection Fraction


Phenotypic Persistence in Heart Failure With Preserved Ejection Fraction

Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, The Netherlands.


Abstract 4146021: Post transcatheter aortic valve replacement outcomes among patients with heart failure with preserved ejection fraction versus heart failure with reduced ejection fraction.

Vikash Jaiswal, Muhammad Hanif, Akash Jaiswal, Adriana Mares, FNU Sundas, Ramesh Daggubati, Kendra Grubb

JCCR Cardiology Research, Jaunpur, India

Abstract: Background: Heart failure with preserved ejection fraction (HFpEF) or heart failure with reduced ejection fraction (HFrEF) is a common comorbidity in patients undergoing transcatheter aortic valve replacement (TAVR). However, post-TAVR outcomes among HFpEF and HFrEF patients have not been well studied. Objective: This study aims to investigate the clinical outcomes post-TAVR among patients with HFrEF vs. HFpEF. Methods: The TriNeTX Global Collaborative Network research database was used to identify patients aged ≥18 years from January 2005 to May 2023. Patients were categorized into two groups: HFpEF and a control group with HFrEF, with both groups of patients undergoing TAVR and followed for 1-month and 1-year. Propensity score-matched analysis (PSM) (1:1) was performed on age, gender, race, body mass index, hypertension, diabetes mellitus, chronic kidney disease, smoking status, hemoglobin level, low density lipid (LDL) level, and various drugs including ACEi, ARBi, beta-blockers, SGLT2i and statins. Primary outcome was all-cause mortality (ACM), while secondary outcomes were acute myocardial infarction (AMI), ischemic stroke, hemorrhagic stroke, major bleeding and major adverse cardiovascular event (MACE) (composite of ACM, AMI and ischemic stroke). Results: After 1:1 propensity score matching ( Figure 1 ), the study cohort comprised of 11, 982 patients in HFpEF with TAVR and 11, 982 patients in the control group. The mean age of patients in HFpEF and HFrEF was 81.7 and 81.5 years, respectively. PSM analysis showed that post-TAVR outcomes among HFpEF patients were significantly associated with lower risk of ACM after 1-month (RR, 0.88 (95%CI: 0.707-0.953), P =0.009), and after 1-year (RR, 0.93 (95% CI: 0.87-0.99), P =0.041) compared with the HFrEF group. A similar trend was observed with a significant reduction in the risk of MACE after 1-month (RR, 0.86, (95% CI: 0.74-0.99), P =0.043), however, it was non-significant after 1-year (RR, 0.942 (95% CI: 0.881-1.007), P =0.077). However, the risk of AMI, ischemic stroke, hemorrhagic stroke, major bleeding both at 1-month and 1-year follow up were comparable between the HFpEF and HFrEF post-TAVR. Conclusion: In patients with HFpEF post-TAVR, there was a significant decrease in ACM at 1-month and 1-year, while there was a significant reduction in MACE only at 1-month. Further investigation is warranted to determine whether HFpEF has better clinical outcomes than patients with HFrEF.


Monitoring Changes in Ejection Fraction in Patients With Heart Failure and Mid-Range Ejection Fraction

Division of Cardiovascular Medicine, Department of Molecular Medicine and Therapeutics, Faculty of Medicine, Tottori University


Echocardiographic Features Beyond Ejection Fraction and Associated Outcomes in Patients With Heart Failure With Mildly Reduced or Preserved Ejection Fraction

Anthony E. Peters, Robert M. Clare, Karen Chiswell, G. Michael Felker, Anita Kelsey, Robert Mentz, Adam D. DeVore

Division of Cardiology, Duke University School of Medicine, Durham, NC (A.E.P., G.M.F., A.K., R.M., A.D.D.).

Abstract: Background: Heart failure (HF) guidelines recommend assessment of left ventricular ejection fraction (LVEF) to classify patients and guide therapy implementation. However, LVEF alone may be insufficient to adequately characterize patients with HF, especially those with mildly reduced or preserved LVEF. Recommendations on additional testing are lacking, and there are limited data on use of echocardiographic features beyond LVEF in patients with heart failure with mildly reduced or preserved LVEF. Methods: In patients with HF with mildly reduced or preserved LVEF identified in a large US health care system, the association of the following metrics with mortality was evaluated: LV global longitudinal strain (LV GLS>–16), left atrial volume index (>28 mL/m 2 ), left ventricular hypertrophy (LVH), and E/e´>13 and e´<9. A multivariable model for mortality was constructed including age, sex, and key comorbidities followed by stepwise selection of echocardiographic features. Characteristics and outcomes of subgroups with normal versus abnormal LV GLS and LVEF were evaluated. Results: Among 2337 patients with complete echocardiographic data assessed between 2017 and 2020, the following features were associated with all-cause mortality on univariate analysis over 3 years of follow-up: E/e´+e´, LV GLS, left atrial volume index (all P <0.01). In the multivariable model ( C -index=0.65), only abnormal LV GLS was independently associated with all-cause mortality (HR, 1.35 [95% CI, 1.11–1.63]; P =0.002). Among patients with LVEF>55%, 498/1255 (40%) demonstrated abnormal LV GLS. Regardless of specific LVEF, patients with abnormal LV GLS demonstrated a higher burden of multiple comorbidities and higher event rates compared with patients with normal LV GLS. Conclusions: In a large, real-world HF with mildly reduced or preserved LVEF population, echocardiographic features, led by LV GLS, were associated with adverse outcomes irrespective of LVEF. A large proportion of patients demonstrate adverse myocardial function by LV GLS despite preserved LVEF and may represent a key cohort of interest for HF medical therapies and future clinical studies.


Pericardiectomy to Treat Heart Failure With Preserved Ejection Fraction

From the Cardiology Unit, University of Vermont, Burlington.


Abstract 15630: Association of Frailty With 30- and 90-day Outcomes in Patients Admitted With Heart Failure With Reduced Ejection Fraction (hfref) and Heart Failure With Preserved Ejection Fraction (hfpef)

Sumitabh Singh, Neha Mulpuri, Nitin Kondamudi, Lin Zhong, Ambarish Pandey

Dept of Internal Medicine, UTSW MEDICAL CENTER, Dallas, TX

Abstract: Background: Frailty is associated with adverse post-hospitalization outcomes among patients admitted with heart failure. Whether frailty associated risk of adverse events among HF patients differs by HF subtype (HFpEF vs. HFrEF) is not well-established. Methods: Using Medicare claims data, we identified patients newly hospitalized for HF in 2016 within a cohort of 5% fee-for-service Medicare beneficiaries and used ICD-10 codes to specify HF subtype. Frailty was quantified using the Hospital Frailty Risk Score (HFRS), which computes frailty using 109 ICD-10 codes within 3 months of the index HF hospitalization. The association of HFRS with risk of outcomes were assessed using adjusted Cox proportional hazard models and multiplicative interaction testing was performed for HF subtype and HFRS. Improvement in model discrimination with addition of HFRS was assessed using change in the C-statistic and the integrated discrimination improvement test (IDI). Results: The study cohort included 14,276 Medicare beneficiaries hospitalized for HF [mean age (SD), 79 (8.4); 53 % women; 88 % white], among them 6836 (48%) with HFpEF and 3586 (25%) with HFrEF. In adjusted Cox models, higher frailty burden was associated with greater risk of 30- and 90- day mortality among beneficiaries hospitalized for HFrEF and HFpEF (Table 1). For readmission outcomes, higher frailty burden was associated with a significantly higher risk of 30-day and 90-day readmission among patients with HFpEF but not HFrEF (p-interaction HFRS * HF subtypes = 0.03 for both, Table 1). Addition of HFRS significantly improve discrimination to predict readmission. [30-day readmission, IDI (95%CI) = 0.011 (0.006-0.016)]. Conclusion: Higher frailty burden is significantly associated with increased risk of mortality in patients with HFpEF and HFrEF. In contrast, frailty is more strongly associated with risk of readmission (30-day and 90-day) among patients with HFpEF only but not among HFrEF.


Factors Associated With Outcome in Heart Failure With Preserved Ejection Fraction

Michel Komajda, Peter E. Carson, Scott Hetzel, Robert McKelvie, John McMurray, Agata Ptaszynska, Michael R. Zile, David DeMets, Barry M. Massie

From the Pitie Salpetriere Hospital–University Pierre and Marie Curie Paris VI (M.K.), Paris, France; Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.), Washington, DC; the Department of Biostatistics and Medical Informatics (S.H.), University of Wisconsin-Madison, Madison, Wis; Hamilton Health Sciences (R.M.), McMaster University, Hamilton, Ontario, Canada; British Heart Foundation Glasgow Cardiovascular Research Centre (J.M.), University of Glasgow, Glasgow, United...

Abstract: Background— The determinants of prognosis in patients with heart failure and preserved ejection fraction (HF-PEF) are poorly documented. Methods and Results— We evaluated data from 4128 patients in the I-PRESERVE trial (Irbesartan in Heart Failure with Preserved Ejection Fraction Study). Multivariable Cox regression models were developed using 58 baseline demographic, clinical, and biological variables to model the primary outcome of all-cause mortality or cardiovascular hospitalization (1505 events), all-cause mortality (881 events), and HF death or hospitalization (716 events). Log N-terminal pro–B-type natriuretic peptide, age, diabetes mellitus, and previous hospitalization for HF were the most powerful factors associated with the primary outcome and with the HF composite. For all-cause mortality, log N-terminal pro–B-type natriuretic peptide, age, diabetes mellitus, and left ventricular EF were the strongest independent factors. Other independent factors associated with poor outcome included quality of life, a history of chronic obstructive lung disease, log neutrophil count, heart rate, and estimated glomerular filtration rate. The models accurately stratified the actual 3-year rate of outcomes from 8.1% to 59.9% (primary outcome) 2.7% to 36.5% (all-cause mortality), and 2.1% to 38.9% (HF composite) for the lowest to highest septiles of predicted risks. Conclusions— In a large sample of elderly patients with HF and preserved EF enrolled in I-Preserve, simple clinical, demographic, and biological variables were associated with outcome and identified subgroups at very high and very low risk of events. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00095238.


Body Mass Index and Adverse Cardiovascular Outcomes in Heart Failure Patients With Preserved Ejection Fraction

Markus Haass, Dalane W. Kitzman, Inder S. Anand, Alan Miller, Michael R. Zile, Barry M. Massie, Peter E. Carson

From the Department of Cardiology, Theresienkrankenhaus, Mannheim, Germany (M.H.); Wake Forest University School of Medicine, Winston-Salem, NC (D.W.K.); VA Medical Center, Minneapolis, MN (I.S.A.); University of Florida, Jacksonville, FL (A.M.); Ralph H. Johnson Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, SC (M.R.Z.); University of California, San Francisco, and San Francisco VAMC, San Francisco, CA (B.M.M.); and Washington VAMC and Georgetown University,...

Abstract: Background— Obesity is a major risk factor for incident heart failure (HF). Paradoxically, in HF with reduced left ventricular ejection fraction (HFREF), a high body mass index (BMI) appears to be beneficial. Approximately 50% of HF patients have a preserved left ventricular ejection fraction (HFPEF). However, there are few data regarding the relationship between BMI and outcomes in HFPEF. Methods and Results— Baseline characteristics and cardiovascular outcomes were assessed in the 4109 patients (mean age, 72 years; mean follow-up, 49.5 months) in the Irbesartan in HF with Preserved Ejection Fraction (I-PRESERVE) trial. Based on the BMI distribution, 5 BMI categories were defined: <23.5, 23.5 to 26.4, 26.5 to 30.9, 31 to 34.9, and ≥35 kg/m 2 . Most patients (71%) had a BMI ≥26.5, 21% had a BMI between 23.5 and 26.4, and 8% had a BMI <23.5 kg/m 2 . Patients with higher BMI were younger, more often women, and more likely to have hypertension and diabetes and higher left ventricular ejection fraction. Patients with BMI of 26.5 to 30.9 kg/m 2 had the lowest rate for the primary composite outcome (death or cardiovascular hospitalization) and were used as reference group. After adjustment for 21 risk variables including age, sex, and N-terminal pro-brain natriuretic peptide, the hazard ratio for the primary outcome was increased in patients with BMI <23.5 (hazard ratio, 1.27; 95% confidence interval, 1.04 to 1.56; P =0.019) and in those with BMI ≥35 kg/m 2 (hazard ratio, 1.27; 95% confidence interval, 1.06 to 1.52; P =0.011) compared with the referent group. A similar relationship was found for all-cause mortality and for HF hospitalization. Conclusions— Obesity is common in HFPEF patients and is accompanied by multiple differences in clinical characteristics. Independent of other key prognostic variables, there was a U-shaped relationship, with the greatest rate of adverse outcomes in the lowest and highest BMI categories. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT000095238.


<i>Circulation: Heart Failure</i> Editors’ Picks


Heart Failure With a Better Ejection Fraction

From the OhioHealth Heart & Vascular Department, Riverside Methodist Hospital, Columbus (A.B.); and Division of Cardiovascular Medicine, University of Utah Health Sciences Center, Salt Lake City (J.C.F.).


Heart Failure With Preserved Ejection Fraction

From the Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, MA.


Characteristics and Clinical Outcomes in Patients with Heart Failure with Preserved Ejection Fraction Compared with Heart Failure with Reduced Ejection Fraction: Insights from the Victorian Cardiac Outcomes Registry Heart Failure Module

C. Tan, D. Dinh, A. Brennan, C. Reid, A. Driscoll, J. Lefkovits, D. Stub


Abstract 11839: Comparisons of Cardiopulmonary Exercise Testing Between Heart Failure With Reduced Ejection Fraction and Preserved Ejection Fraction

Takamasa Sato, Yuki Kanno, Akiomi Yoshihisa, Yasuchika Takeishi

Dept of Cardiovascular Medicine, Fukushima Med Univ, Fukushima, Japan

Abstract: Background: Parameters derived from cardiopulmonary exercise testing (CPET) are important prognostic markers, especially peak oxygen consumption (VO 2 ), the minute ventilation carbon dioxide production slope (VE/VCO 2 slope), exertional oscillatory ventilation (EOV) and oxygen uptake efficiency slope (OUES) in chronic heart failure (CHF). However, the significance of these parameters has not been examined in terms of left ventricular ejection fraction (EF). We aimed to compare the impacts of these exercise parameters on clinical outcomes between CHF patients with reduced EF (HFrEF) and preserved EF (HFpEF). Methods: We analyzed 1190 patients (969 males, mean age 61.0 years) with CHF who admitted to our hospital and performed CPET. We divided subjects into two groups: HFrEF (LVEF<45%, n=655) and HFpEF (LVEF≥45%, n=535). We compared the independent factors to predict adverse composite cardiac events (cardiac deaths and rehospitalization due to worsening heart failure), cardiac deaths and all-cause deaths between HFrHF and HFpEF. Results: In the follow-up period (mean 1155 days), 407 adverse cardiac events (rehospitalization due to worsening heart failure and cardiac deaths), 172 cardiac deaths and 247 all-cause deaths were occurred. Kaplan-Meier analyses demonstrated that composite cardiac event rates, cardiac and all-cause mortalities were significantly higher in HFrEF than in HFpEF (P<0.001, respectively). In Cox proportional hazard multivariate analyses, independent predictors of composite adverse events were peak VO 2 , VE/VCO 2 slope and OUES in HFrEF (P<0.001, P<0.001 and P=0.001, respectively), those of cardiac deaths were peak VO 2 , OUES and VE/VO 2 slope (P=0.002, P=0.005 and P=0.008, respectively), and those of all-cause deaths were peak VO 2 , OUES and VE/VCO 2 slope (P=0.001 and P=0.023 and P=0.041, respectively) in HFrEF. On the other hands, the independent predictors of composite adverse events were peak VO2 and VE/VCO2 slope (P<0.001 and P=0.041), and those of cardiac deaths and all cause deaths were peak VO 2 in HFpEF (P<0.001 and P=0.001, respectively). Conclusion: Impacts of these parameters were different between HFrEF and HFpEF based on several clinical outcomes.


Heart Failure With Preserved Ejection Fraction: From a Vascular Perspective

Guillaume Goudot, Marie Denise Gerhard-Herman

Vascular Medicine Department, Université Paris Cité, Vascular Medicine Department, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France. Vascular Medicine Department, Université Paris Cité, Georges Pompidou European Hospital, Assistance Publique - Hôpitaux de Paris, France (G.G.).


Heart Failure Mid-Range Ejection Fraction ― Heart Failure With Multiple Personalities ―

Cardiovascular Medicine, Saitama Medical Center Jichi Medical University


Effects of Exercise on Left Ventricular Systolic and Diastolic Properties in Patients With Heart Failure and a Preserved Ejection Fraction Versus Heart Failure and a Reduced Ejection Fraction

Michael R. Zile, Barbro Kjellstrom, Tom Bennett, Yong Cho, Catalin F. Baicu, Mark F. Aaron, William T. Abraham, Robert C. Bourge, Fred J. Kueffer

From the Medical University of South Carolina and RHJ Department of Veterans Affairs Medical Center, Charleston, SC (M.R.Z., C.F.B.); Cardiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden (B.K.); Medtronic, Inc, Minneapolis, MN (T.B., Y.C., F.J.K.); St Thomas Hospital, Nashville, TN (M.F.A.); Ohio State University, Columbus, OH (W.T.A.), and University of Alabama at Birmingham, Birmingham, AL (R.C.B.).

Abstract: Background— The purpose of the current study was to define exercise-induced changes in indices of left ventricular (LV) systolic and diastolic properties in patients with chronic heart failure (HF), compare these changes in patients with HF and a reduced ejection fraction (EF) versus HF and a preserved EF, and compare the hemodynamic responses to activities of daily living with symptom-limited upright exercise. Methods and Results— Subjects with HF and a preserved EF (n=8) and subjects with HF and a reduced EF (n=5) underwent symptom-limited Naughton protocol treadmill exercise tests. Implantable hemodynamic monitor data and echocardiographic data were obtained before exercise and at peak exercise. Implantable hemodynamic monitor data were obtained during activities of daily living during a 24-hour time period. In patients with HF and a reduced EF, limited exercise time (639±164 seconds) was associated with a marked rise in right ventricular systolic, diastolic, and estimated pulmonary artery diastolic (ePAD) pressures and an increase in LV end diastolic volume (EDV). LV systolic properties, namely EF, end systolic elastance, stroke work, and preload recruitable stroke work, all decreased. The ePAD/EDV ratio increased; to a large extent, this was dependent on an increase in EDV. By contrast, in HF and a preserved EF, limited exercise time (411±128 seconds) and the marked rise in right ventricular systolic, diastolic, and ePAD pressures were associated with no change in LV EDV. LV systolic properties increased or were unchanged; ePAD/EDV ratio increased during exercise, but the increase was independent of a change in EDV. The ranges of right ventricular systolic, diastolic, and ePAD pressures during activities of daily living were higher than the ranges of these values during the exercise stress test. Conclusions— Although exercise limitations were similar between HF and a reduced EF and HF and a preserved EF, there were significant differences in exercise-induced changes in LV systolic and diastolic properties. These differences likely reflect the different pathophysiologies of these clinical syndromes of HF.


Pulmonary Hypertension in Heart Failure Preserved Ejection Fraction

From the Heart Failure Unit and Cardiopulmonary Laboratory, Cardiology, IRCCS, Policlinico San Donato University Hospital, Milan, Italy.


Prescription Rates of Guideline-Directed Medical Therapy in Cardiology Patients Admitted With Heart Failure With Reduced Ejection Fraction (HFrEF) or Heart Failure With Mildly Reduced Ejection Fraction (HFmrEF)

R. Lambert, J. Ang, A. Hijazi, R. Useelananthan, U. Premawardhana, K. Kadappu


Heart Rate and Heart Failure With Preserved Ejection Fraction

Cardiology Unit, Department of Medicine, Larner College of Medicine at the University of Vermont, Burlington.


Abstract 4141805: High Frequency of Ejection Fraction Decline in Patients with Heart Failure with Improved Ejection Fraction

Anthony Pensa, Lucia Davis, Tingqing Wu, Veronica Zheng, Rebecca Harap, Jane Wilcox

Northwestern University, Chicago, Illinois, United States

Abstract: Background: Heart failure with improved ejection fraction (HFimpEF) is defined by prior HF with reduced EF (HFrEF) and evidence of systolic improvement and is associated with improved outcomes. Despite this, HFimpEF patients remain at risk of future adverse events, including EF decline. However, little is known about factors associated with EF trajectory in this population. Question: Are baseline clinical characteristics associated with future EF decline in HFimpEF? Goals: To describe the EF trajectory in HFimpEF and to identify if clinical characteristics are predictive of eventual EF decline. Methods: This was a retrospective observational study of 115 patients in our HFimpEF registry. Inclusion criteria were a history of HFimpEF (prior HFrEF [EF ≤40%] with subsequent EF improvement ≥10% and resulting EF >40%) and at least one follow-up echocardiogram after improvement. The primary outcome was EF decline (EF drop ≥10% from peak improvement EF). Cox proportional hazard models were built using baseline factors at time of HFrEF diagnosis to identify predictors of EF decline. Results: The median time from initial HFrEF diagnosis to development of HFimpEF was 0.61 years (IQR 0.26-1.17). Most patients (77%) continued to have EF improvement after HFimpEF diagnosis, and the peak EF was 60% (IQR 54-65%). Over a mean follow-up of 4.7±3.2 years, 35 (30%) HFimpEF patients developed EF decline. Baseline characteristics were similar between those with sustained EF and EF decline ( Table 1 ), as was peak EF (60.0% vs 60.3%, p=0.571). Indexed end-systolic dimension (1.78 vs 1.93 cm/m 2 , p=0.014) was smaller at time of HFimpEF diagnosis in those with sustained EF. In multivariate analysis, current/former tobacco use was associated with EF decline (HR 2.60, 95% CI 1.02-6.63, p=0.045; Table 2 ). Conclusions: Many HFimpEF patients develop EF decline, highlighting the need for continual clinical follow up in this high-risk patient population.


Heart Failure With Preserved Ejection Fraction vs. Reduced Ejection Fraction ― Mechanisms of Ventilatory Inefficiency During Exercise in Heart Failure ―

Shingo Tsujinaga, Hiroyuki Iwano, Yasuyuki Chiba, Suguru Ishizaka, Miwa Sarashina, Michito Murayama, Masahiro Nakabachi, Hisao Nishino, Shinobu Yokoyama, Kazunori Okada, Sanae Kaga, Toshihisa Anzai

Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University


Hypertension, Heart Failure, and Ejection Fraction

From the Section of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC.


Correction to: “Polygenic Score for β-Blocker Survival Benefit in European Ancestry Patients With Reduced Ejection Fraction Heart Failure”


Why We Should Care About Who Cares for Patients With Heart Failure With Preserved Ejection Fraction

Division of Cardiology, Department of Medicine, and Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Chicago, IL.


Correction to: Heart Failure With Preserved Ejection Fraction: A Kidney Disorder?


Abstract P2086: Targeting Endothelial Dysfunction And Senescence An Heart Failure With Preserved Ejection Fraction - A Whole Transcriptome Analysis Of Heart Failure With Preserved Ejection Fraction-patients To Identify New Therapeutic Targets

Leonie Wurmbrand, Katrin Kalies, Kai Knoepp, Jochen Dutzmann, Daniel SEDDING

Abstract: Heart failure with preserved ejection fraction (HFpEF) remains a disease with a poor prognosis and increasing incidence in all Western countries mainly affecting the aging population. A deeper understanding of pathogenesis at the cellular level, particularly the central role of endothelial dysfunction in cellular senescence, is required for the development of new therapeutic approaches. Circulating endothelial cells as a marker for endothelial damage and dysfunction, have already been examined quantitatively in general HF patients, HFpEF patients and healthy subjects. Here, we aim to isolate circulating endothelial cells to target endothelial dysfunction and identify new therapeutic targets by whole transcriptome analysis.Methods included the isolation of circulating endothelial cells (CEC) from whole blood samples via a newly established FACS panel. HFpEF patients were included based on their HFA-PEFF score. Young and old subjects served as non-diseased controls and were matched as closely as possible for sex and age. CEC were further processed for a whole transcriptome analysis. In total, we collected samples from n=15 patients per group. Mean age was 82.3 for the HFpEF group, 64.5 for the non-diseased control ‘old’, and 25 years for the non- diseased control ‘young’, HFA-PEFF score was 5, 0, and 0 points (P<0.05), and the proportion of female patients was 66%, 78%, and 77%, respectively. Including additional patient data, our collective was shown to be comparable to large HFpEF studies and clinical registries. CEC cells were sorted based on CD45-, CD11b- CD34+, CD31+ and CD146+ marker expression. The CEC of the aged group revealed upregulated expression of senescence markers p16, p21 and CD44. In gene set enrichment analysis, we see trends of differentiation of mainly proliferation- and transcription-associated gene sets in heart failure with preserved ejection fraction. In summary, we achieved to isolate CEC from whole blood of HFpEF-patients and matched controls. The whole transcriptome analyses may provide new clues for therapeutic strategies, which is now the subject of further in vitro and in vivo studies. Our goal is to develop new therapeutic targets after successful evaluation and modulation of the target genes.


Improvement in Left Ventricular Ejection Fraction in Outpatients With Heart Failure With Reduced Ejection Fraction

Adam D. DeVore, Anne S. Hellkamp, Laine Thomas, Nancy M. Albert, Javed Butler, J. Herbert Patterson, John A. Spertus, Fredonia B. Williams, Carol I. Duffy, Adrian F. Hernandez, Gregg C. Fonarow

Duke Clinical Research Institute, Durham, NC (A.D.D., A.S.H., L.T., A.F.H.).

Abstract: Background: Among patients with heart failure (HF) with reduced ejection fraction (EF), improvements in left ventricular EF (LVEF) are associated with better outcomes and remain an important treatment goal. Patient factors associated with LVEF improvement in routine clinical practice have not been clearly defined. Methods: CHAMP-HF (Change the Management of Patients with Heart Failure) is a prospective registry of outpatients with HF with reduced EF. Assessments of LVEF are recorded when performed for routine care. We analyzed patients with both baseline and ≥1 follow-up LVEF assessments to describe factors associated with LVEF improvement. Results: In CHAMP-HF, 2623 patients had a baseline and follow-up LVEF assessment. The median age was 67 (interquartile range, 58–75) years, 40% had an ischemic cardiomyopathy, and median HF duration was 2.8 years (0.7–6.8). Median LVEF was 30% (23–35), and median change on follow-up was 4% (−2 to −13); 19% of patients had a decrease in LVEF, 31% had no change, 49% had a ≥5% increase, and 34% had a ≥10% increase. In a multivariable model, the following factors were associated with ≥5% LVEF increase: shorter HF duration (odds ratio [OR], 1.21 [95% CI, 1.17–1.25]), no implantable cardioverter defibrillator (OR, 1.46 [95% CI, 1.34–1.55]), lower LVEF (OR, 1.15 [95% CI, 1.10–1.19]), nonischemic cardiomyopathy (OR, 1.24 [95% CI, 1.09–1.36]), and no coronary disease (OR, 1.20 [95% CI, 1.03–1.35]). Conclusions: In a large cohort of outpatients with chronic HF with reduced EF, improvements in LVEF were common. Common baseline cardiac characteristics identified a population that was more likely to respond over time. These data may inform clinical decision making and should be the basis for future research on myocardial recovery.


Correction to: Prognostic Value of Albuminuria and Influence of Spironolactone in Heart Failure With Preserved Ejection Fraction: The TOPCAT Trial


Conventional Wisdom in Heart Failure Treatment Challenged Again

From Sections on Cardiovascular Medicine and Gerontology, Wake Forest School of Medicine, Winston-Salem, NC.


Atrioventricular Dyssynchrony and Dyspnea in Heart Failure With Preserved Ejection Fraction

Teodora Donisan, Sara Inglis, Samuel J. Asirvatham, Barry A. Borlaug

Division of Cardiovascular Diseases, Department of Medicine (T.D., S.I., S.J.A., B.A.B.), Mayo Clinic, Rochester, MN.


Letter by Prakash Regarding Article “Impaired Heart Rate Recovery and Chronotropic Incompetence in Patients With Heart Failure With Preserved Ejection Fraction”

Department of Physiology, Faculty of Medicine, AIMST University, Bedong, Kedah, Malaysia


Microvascular Paradigm in Heart Failure With Preserved Ejection Fraction

From the Department of Physiology, Amsterdam Cardiovascular Sciences, VU University Medical Center, The Netherlands.


Sex and Race Differences in Lifetime Risk of Heart Failure With Preserved Ejection Fraction and Heart Failure With Reduced Ejection Fraction

Ambarish Pandey, Wally Omar, Colby Ayers, Michael LaMonte, Liviu Klein, Norrina B. Allen, Lewis H. Kuller, Philip Greenland, Charles B. Eaton, John S. Gottdiener, Donald M. Lloyd-Jones, Jarett D. Berry

Division of Cardiology (A.P., W.O., C.A., J.D.B.)

Abstract: Background: Lifetime risk of heart failure has been estimated to range from 20% to 46% in diverse sex and race groups. However, lifetime risk estimates for the 2 HF phenotypes, HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), are not known. Methods: Participant-level data from 2 large prospective cohort studies, the CHS (Cardiovascular Health Study) and MESA (Multiethnic Study of Atherosclerosis), were pooled, excluding individuals with prevalent HF at baseline. Remaining lifetime risk estimates for HFpEF (EF ≥45%) and HFrEF (EF <45%) were determined at different index ages with the use of a modified Kaplan-Meier method with mortality and the other HF subtype as competing risks. Results: We included 12 417 participants >45 years of age (22.2% blacks, 44.8% men) who were followed up for median duration of 11.6 years with 2178 overall incident HF events with 561 HFrEF events and 726 HFpEF events. At the index age of 45 years, the lifetime risk for any HF through 90 years of age was higher in men than women (27.4% versus 23.8%). Among HF subtypes, the lifetime risk for HFrEF was higher in men than women (10.6% versus 5.8%). In contrast, the lifetime risk for HFpEF was similar in men and women. In race-stratified analyses, lifetime risk for overall HF was higher in nonblacks than blacks (25.9% versus 22.4%). Among HF subtypes, the lifetime risk for HFpEF was higher in nonblacks than blacks (11.2% versus 7.7%), whereas that for HFrEF was similar across the 2 groups. Among participants with antecedent myocardial infarction before HF diagnosis, the remaining lifetime risks for HFpEF and HFrEF were up to 2.5-fold and 4-fold higher, respectively, compared with those without antecedent myocardial infarction. Conclusions: Lifetime risks for HFpEF and HFrEF vary by sex, race, and history of antecedent myocardial infarction. These insights into the distribution of HF risk and its subtypes could inform the development of targeted strategies to improve population-level HF prevention and control.


Abstract 13786: Effectiveness of Ambulatory Pulmonary Artery Pressure-Guided Therapy in Reducing Readmissions in Patients With Heart Failure With Reduced Ejection Fraction versus Heart Failure With Preserved Ejection Fraction

Akshay Goel, Aaqib H Malik, Dhrubajyoti Bandyopadhyay, Rahul Gupta, Adrija Hajra, Alexandros Briasoulis, Wilbert S Aronow, Julio A Panza, Gregg Lanier

Westchester Med Cntr, New York Med College, Valhalla, NY

Abstract: Introduction: The cardio-microelectromechanical system (CardioMEMS) is an implantable pulmonary artery pressure monitoring device that aims to avoid decompensated heart failure (HF) admissions through hemodynamic-guided care. The aim of our study was to compare the impact of CardioMEMS implantation on hospital readmissions between HFrEF and HFpEF patients. Methods: Data from the National Readmission Database 2015 to 2019 were analyzed. International Classification of Diseases codes were used to identify patients hospitalized for HF and those with CardioMEMS implantation. The outcome of interest was the 30-day readmission rate. Multivariate logistic regression analysis was done to account for possible confounders. Results: We identified 3,801,661 admissions with a primary diagnosis of HF. Of these, 2,279,203 (59.95%) patients carried a diagnosis of HFrEF, while 1,522,458 (40.05%) had HFpEF. Patient characteristics are shown in the table. CardioMEMS was implanted in 1100 patients with HFrEF, and 297 patients with HFpEF. Among patients with HFrEF, those who received CardioMEMS implantation during the index admission had a significantly lower 30-day readmission rate compared to those who did not (16.4% vs 21.0%, adjusted odds ratio [OR] 0.74, 95% confidence interval [CI] 0.63-0.87, p <0.01) (Figure). However, among HFpEF patients, there was no significant reduction in 30-day readmissions after CardioMEMS implantation (19.8% vs 20.7%, adjusted OR 0.95, 95% CI 0.72-1.27, p = 0.37) (Figure). CardioMEMS implantation was not associated with a higher rate of complications such as major bleeding, acute kidney injury, or stroke, in both HFrEF and HFpEF groups. Conclusions: Our findings suggest that ambulatory pulmonary artery pressure-guided therapy may be more effective in reducing HF readmissions in patients with HFrEF than in those with HFpEF. This may have significant clinical implication in appropriate patient selection for CardioMEMS implantation.


Zooming in on the Microvasculature in Heart Failure With Preserved Ejection Fraction

Selma F. Mohammed, David T. Majure, Margaret M. Redfield

From the MedStar Cardiovascular Research Network, Washington, DC (S.F.M., D.T.M.); and Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN (M.M.R.).


Changes in Left Ventricular Ejection Fraction (LVEF) Predict Mortality in Heart Failure Patients With Reduced Ejection Fraction

L. Kearney, A. Williamson, E. Chowdhury, M. Duong, J. McGillion, N. Schwarz, D. Eccleston


Carbon Dioxide Utilization and Sequestration in Kerogen Nanopores

Carbon Capture, Utilization and Sequestration


Interfacial Tension and Contact Angle Data Relevant to Carbon Sequestration


An Innovative Approach in Post Combustion Carbon Capture and Sequestration towards Reduction of Energy Penalty in Regeneration of Solvent


Biomimetic mineralization for carbon capture and sequestration


Carbon Sequestration in Soils: The Opportunities and Challenges

Ahmed Chinade Abdullahi, Chamhuri Siwar, Mohamad Isma’il Shaharudin, Isahak Anizan


Assessment of carbon capture techniques and their carbon sequestration potential, technical characteristics, and cost.


Carbon Capture and Storage (CCS): Geological Sequestration of CO2

Nediljka Gaurina-Međimurec, Karolina Novak Mavar


Blue Carbon on Polar and Subpolar Seabeds


Enhancing Carbon Sequestration Using Organic Amendments and Agricultural Practices

Zia Ur Rahman Farooqi, Muhammad Sabir, Nukshab Zeeshan, Khurram Naveed, Muhammad Mahroz Hussain


Emerging towards zero carbon footprint via carbon dioxide capturing and sequestration

Anjana Krishnan, Amrita Nighojkar, Balasubramanian Kandasubramanian


CO2-enriched ammonium solutions for enhanced carbon capture and sequestration in cement systems

Ahmed Fatah, Ahmed Al-Yaseri, Rida Assaggaf, Hani Al-Mukainah


Carbon Capture, Sequestration, and Utilization

The Carbon Footprint of our Primary Energy Sources


Carbon capture and sequestration versus carbon capture utilisation and storage for enhanced oil recovery


Terrestrial sequestration of carbon dioxide (CO2)

Developments and Innovation in Carbon Dioxide (CO2) Capture and Storage Technology


Chemical Absorption by Aqueous Solution of Ammonia


Carbon Capture and Sequestration


CO 2 utilization and other sequestration options


Carbon Capture, Transport and Geologic Storage: A Brief Introduction

Nikhil Jain, Akash Srivastava, T. N. Singh


Carbon Capture, Utilization, and Sequestration

Richard C. Selley, Stephen A. Sonnenberg


Carbon Capture Using Amine‐Based Technology

Carbon Dioxide Sequestration and Related Technologies


Sustainability of microbial carbon capture cells for carbon sequestration and biomass generation

Advances in Environmental Electrochemistry


Carbon Capture and Storage in Geologic Formations

Carbon Sequestration for Climate Change Mitigation and Adaptation


Ocean sequestration of carbon dioxide (CO2)


Storage capacity estimates and site conditions of potential locations for offshore-wind powered carbon dioxide removal and carbon sequestration in ocean basalt

Heather Norton, Devin Todd, Curran Crawford


Tracking CO2 Migration in Storage Aquifer

Luqman Kolawole Abidoye, Diganta Bhusan Das


Nitrogen-rich hierarchical porous carbon paper for a free-standing cathode of lithium sulfur battery

Jae Hyun Park, Won Yeong Choi, Jeongwoo Yang, Dohyeun Kim, Hyeonseo Gim, Jae W. Lee

Ministry of Science, ICT and Future Planning, Korea Carbon Capture and Sequestration R and D Center, Korea Carbon Capture and Sequestration R and D Center


Direct air capture (DAC) and CO2 sequestration with waste brine using a novel sorbent at ambient temperature

Xinkai Wu, Hao Chen, Haibo Liu, Arup K. SenGupta


Transformation of carbon dioxide into carbon nanotubes for enhanced ion transport and energy storage

Gi Mihn Kim, Won-Gwang Lim, Dohyung Kang, Jae Hyun Park, Hyunjoo Lee, Jinwoo Lee, Jae W. Lee

Department of Chemical and Biomolecular Engineering

Korea Carbon Capture and Sequestration R and D Center, Korea Carbon Capture and Sequestration R and D Center

Abstract: CO 2 -derived-CNTs (CCNTs) prepared at 500–700 °C (1 atm) show excellent supercapacitance due to B/O doping and fast ion transport through mesoporous CCNT fibers.


Energy transition impact on unconventional reservoirs: Carbon capture and sequestration


Power and Energy Requirements for Carbon Capture and Sequestration

Department of Engineering, Texas Christian University, Fort Worth, TX 76129, USA

Abstract: Carbon capture and sequestration have been recently presented as a viable option to reduce atmospheric carbon dioxide emissions and mitigate global climate change. The concept entails the capture, compression, transportation, and injection of the gas into a medium suitable for storage. This paper examines the thermodynamic and transport properties of carbon dioxide that are pertinent to its sequestration and storage, describes the various methods that have been recommended for its separation from the mixture of the flue gases, and determines the mechanical power and heat rate required for the capture of the gas. The power required for the compression and transportation of the gas by a pipeline is also determined, as well as the effect of the ambient temperature on the transportation power. Calculations for the total power required are performed for two cases, one a cement production unit and the second a coal power plant. The mechanical power needed for the sequestration of CO2 is substantial in both cases, with the cement unit needing less power because of the availability of high-temperature waste heat. In both cases, the equivalent mechanical work needed for the sequestration and storage of this gas is on the order of 1 MJ per kg CO2 sequestered.


Direct Air Carbon Capture and Sequestration


Investigating carbon sequestration in cementitious mortars with low-carbon binders and carbonated water

Aswathy Rajendran, Sripriya Rengaraju, Abir Al-Tabbaa

Engineering and Physical Sciences Research Council


CO2 Miscible Flooding for Enhanced Oil Recovery

Abdelaziz Nasr El-hoshoudy, Saad Desouky


Chemical looping partial oxidation of methane with CO2 utilization on the ceria-enhanced mesoporous Fe2O3 oxygen carrier

Dohyung Kang, Minbeom Lee, Hyun Suk Lim, Jae W. Lee


Carbon Capture, Use and Storage (CCUS) as Enhanced Oil Recovery (EOR): Llanos Orientales Basin (Colombia)

Jorge Eliecer Mariño Martínez, Luisa Epimenia Moreno Reyes

Abstract: At present, it is essential to take actions to minimize CO2 emissions into the atmosphere, and one way to use and exploit it is through the use of carbon dioxide for industry processes, such as enhanced oil recovery. By carrying out carbon capture, geological storage and improving oil recovery by applying the selection criteria to determine suitability for CO2 sequestration in the Llanos Orientales Basin as a tool to improve hydrocarbon production. It would be a first step in the sustainable development of the extractive oil industry in Colombia, which is one of the participants in greenhouse gas releases. The above can be achieved through the application of CO2–EOR processes, which are mainly miscible or immiscible methods. Finally, the importance of identifying existing CO2 sources is highlighted, in order to carry out the application of a CO2–EOR project.


Geophysical Monitoring of CO2 Injection at Citronelle Field, Alabama


Carbon Capture and Sequestration: Implications and Opportunities for India


Potential Evaluation Method of Carbon Dioxide Flooding and Sequestration

Yongle Hu, Mingqiang Hao, Chao Wang, Xinwei Liao, Lina Song


Accelerating CO2 sequestration in cementitious materials using carbonic anhydrase: Experimental insights into performance and mechanisms


Optimization of the Energy Consumption of a Carbon Capture and Sequestration Related Carbon Dioxide Compression Processes

Instituttet for ingeniørvitenskap og sikkerhet IVT, UiT Norges Arktiske Universitet, 9019 Tromsø, Norway

Abstract: It is likely that the future availability of energy from fossil fuels, such as natural gas, will be influenced by how efficiently the associated CO2 emissions can be mitigated using carbon capture and sequestration (CCS). In turn, understanding how CCS affects the efficient recovery of energy from fossil fuel reserves in different parts of the world requires data on how the performance of each part of a particular CCS scheme is affected by both technology specific parameters and location specific parameters, such as ambient temperature. This paper presents a study into how the energy consumption of an important element of all CCS schemes, the CO2 compression process, varies with compressor design, CO2 pipeline pressure, and cooling temperature. Post-combustion, pre-combustion, and oxyfuel capture scenarios are each considered. A range of optimization algorithms are used to ensure a consistent approach to optimization. The results show that energy consumption is minimized by compressor designs with multiple impellers per stage and carefully optimized stage pressure ratios. The results also form a performance map illustrating the energy consumption for CO2 compression processes that can be used in further study work and, in particular, CCS system models developed to study performance variation with ambient temperature.


Advanced Technologies for Carbon Sequestration and Capture


Membrane-based technology for carbon dioxide capture and sequestration

Membrane-Based Technologies for Environmental Pollution Control


Front Matter


Biogenic Carbon—Capture and Sequestration

Greenhouse Gases Balances of Bioenergy Systems

Zoe M. Harris, Suzanne Milner, Gail Taylor


Feasibility of Ex‐Situ Dissolution for Carbon Dioxide Sequestration

Cutting‐Edge Technology for Carbon Capture, Utilization, and Storage


Carbon capture and sequestration: a critical view of its future


Carbon capture and sequestration with in-situ CO2 and steam integrated 3D concrete printing

Sean Gip Lim, Yi Wei Daniel Tay, Suvash Chandra Paul, Junghyun Lee, Issam T. Amr, Bandar A. Fadhel, Aqil Jamal, Ahmad O. Al-Khowaiter, Ming Jen Tan


Carbon Dioxide Capture and Sequestration by Adsorption on Activated Carbon

Reema Saxena, Vinod Kumar Singh, E. Anil Kumar


Coupling carbon dioxide sequestration with geothermal energy capture in naturally permeable, porous geologic formations: Implications for CO2 sequestration


Sex-linked deubiquitinase establishes uniparental transmission of chloroplast DNA

Sunjoo Joo, Thamali Kariyawasam, Minjae Kim, EonSeon Jin, Ursula Goodenough, Jae-Hyeok Lee

Korea Polar Research Institute, Korea Carbon Capture and Sequestration R and D Center, Korea Carbon Capture and Sequestration R and D Center, National Science Foundation, UBC | Faculty of Graduate Studies, University of British Columbia, Gouvernement du Canada | Natural Sciences and Engineering Research Council of Canada, Korea Carbon Capture and Sequestration R and D Center

Abstract: AbstractMost sexual organisms inherit organelles from one parent, commonly by excluding organelles from the smaller gametes. However, post-mating elimination of organelles derived from one gamete ensures uniparental inheritance, where the underlying mechanisms to distinguish organelles by their origin remain obscure. Mating in Chlamydomonas reinhardtii combines isomorphic plus and minus gametes, but chloroplast DNA from minus gametes is selectively degraded in zygotes. Here, we identify OTU2p (otubain protein 2), encoded in the plus mating-type locus MT+, as the protector of plus chloroplast. Otu2p is an otubain-like deubiquitinase, which prevents proteasome-mediated degradation of the preprotein translocase of the outer chloroplast membrane (TOC) during gametogenesis. Using OTU2p-knockouts and proteasome inhibitor treatment, we successfully redirect selective DNA degradation in chloroplasts with reduced TOC levels regardless of mating type, demonstrating that plus-specific Otu2p establishes uniparental chloroplast DNA inheritance. Our work documents that a sex-linked organelle quality control mechanism drives the uniparental organelle inheritance without dimorphic gametes.


Effects of climate -induced coral bleaching on coral -reef fishes — ecological and economic consequences


Coral bleaching, bleaching-induced mortality, and the adaptive significance of the bleaching response


Alternate coral–bryozoan competitive superiority during coral bleaching


Coral Bleaching and Climate Change


Evidence that reef-wide patterns of coral bleaching may be the result of the distribution of bleaching-susceptible clones


Climate change, coral bleaching and the future of the world's coral reefs

Abstract: Sea temperatures in many tropical regions have increased by almost 1°C over the past 100 years, and are currently increasing at ~1–2°C per century. Coral bleaching occurs when the thermal tolerance of corals and their photosynthetic symbionts (zooxanthellae) is exceeded. Mass coral bleaching has occurred in association with episodes of elevated sea temperatures over the past 20 years and involves the loss of the zooxanthellae following chronic photoinhibition. Mass bleaching has resulted in significant losses of live coral in many parts of the world. This paper considers the biochemical, physiological and ecological perspectives of coral bleaching. It also uses the outputs of four runs from three models of global climate change which simulate changes in sea temperature and hence how the frequency and intensity of bleaching events will change over the next 100 years. The results suggest that the thermal tolerances of reef-building corals are likely to be exceeded every year within the next few decades. Events as severe as the 1998 event, the worst on record, are likely to become commonplace within 20 years. Most information suggests that the capacity for acclimation by corals has already been exceeded, and that adaptation will be too slow to avert a decline in the quality of the world’s reefs. The rapidity of the changes that are predicted indicates a major problem for tropical marine ecosystems and suggests that unrestrained warming cannot occur without the loss and degradation of coral reefs on a global scale.


Symbiont specificity and bleaching susceptibility among soft corals in the 1998 Great Barrier Reef mass coral bleaching event

Tamar L. Goulet, Todd C. LaJeunesse, Katharina E. Fabricius


Two time losers: selective feeding by crown-of-thorns starfish on corals most affected by successive coral-bleaching episodes on western Australian coral reefs

John K. Keesing, Damian P. Thomson, Michael D. E. Haywood, Russell C. Babcock


Effects Of Climate-Induced Coral Bleaching On Coral-Reef Fishes ‚Äî Ecological And Economic Consequences

Oceanography and Marine Biology - An Annual Review

Morgan Pratchett, Philip Munday, Shaun Wilson, Nicholas Graham, Joshua Cinner, David Bellwood, Geoffrey Jones, Nicholas Polunin, Tim Mcclanahan


Coral bleaching — capacity for acclimatization and adaptation


Resilience in carbonate production despite three coral bleaching events in 5 years on an inshore patch reef in the Florida Keys

Derek P. Manzello, Ian C. Enochs, Graham Kolodziej, Renée Carlton, Lauren Valentino

NOAA Coral Reef Conservation Program and Ocean Acidification Program


The 1998 bleaching event and its aftermath on a coral reef in Belize

Aronson R., Precht W., Toscano M., Koltes K.


Marine Water Acidification and Coral Bleaching

Saidat Omowunmi Adeniran-Obey, Patrick Omoregie Isibor, Tunde Ohiokhioya Imoobe


Recovery trajectories of oceanic reef ecosystems following multiple mass coral bleaching events

Fanny Vessaz, Charles J. Marsh, Jude Bijoux, Gilberte Gendron, Christophe Mason-Parker


Coefficient of variation of sea surface temperature (SST) as an indicator of coral bleaching

Paul W. Sammarco, Amos Winter, J. Cody Stewart


Ecological versatility and the decline of coral feeding fishes following climate driven coral mortality


Back-to-back bleaching events in Peninsular Malaysia (2019–2020) selectively affect hard coral taxa across- and within-reef scales

Sebastian Szereday, Christian R. Voolstra, Affendi Y. Amri

Abstract: AbstractThe impacts of (repeat) bleaching events and the differential heat stress susceptibility of hard coral taxa are largely unknown in Malaysia, although it is part of the greater coral triangle. Here we determined bleaching trajectories of 46 hard coral taxa across- and within-reef scales based on data recorded during the first reported back-to-back coral bleaching occurrences in Malaysia between May 2019 and September 2020. Although the severity of coral bleaching in both years did not correspond to the rather small magnitude of heat stress observed, i.e., Degree Heating Weeks (DHW) of 1.05 °C-weeks and 0 °C-weeks in 2019 and 2020 respectively, we observed high levels of bleaching (55.21% and 26.63% of all surveyed colonies in 2019 and 2020, respectively). Notably, the bleaching response for both consecutive years was highly taxon-specific and significantly varied across- and within-reef scales. Mortality rates overall were low following the 2019 event, likely due to a rapid decrease in heat stress. Five of the 46 surveyed hard coral taxa exhibited more severe bleaching in 2020, despite a lower heat stress load. Interestingly, we observed low bleaching of ascribed susceptible taxa such as Acropora and Montipora, while we found taxa considered to be resilient, e.g. Heliopora and Porites, to exhibit severe bleaching, suggesting a reversal of bleaching hierarchies of taxa over time. Our findings provide a foundation for further coral bleaching studies in a region with few published records to enable more accurate regional assessments and to follow the trajectory of future coral bleaching events.


Long-term changes in coral colony size distributions on Kenyan reefs under different management regimes and across the 1998 bleaching event

T. R. McClanahan, M. Ateweberhan, J. Omukoto


Photoinhibition of Symbiodinium spp. within the reef corals Montastraea faveolata and Porites astreoides: implications for coral bleaching

Sebastian J. Hennige, Michael P. McGinley, Andréa G. Grottoli, Mark E. Warner


Interpreting the sign of coral bleaching as friend vs. foe


Increased mortality and photoinhibition in the symbiotic dinoflagellates of the Indo–Pacific coral Stylophora pistillata (Esper) after summer bleaching

Daniel J. Franklin, Cristina M. Molina Cedrés, Ove Hoegh-Guldberg


Differential bleaching susceptibility among coral taxa and colony sizes, relative to bleaching severity across Australia's Great Barrier Reef and Coral Sea Marine Parks

D. Burn, A.S. Hoey, S. Matthews, H.B. Harrison, M.S. Pratchett


Growth and bleaching of the coral Oculina patagonica under different environmental conditions in the western Mediterranean Sea

Esther Rubio-Portillo, Maite Vázquez-Luis, Carlos Valle, Andrés Izquierdo-Muñoz, Alfonso A. Ramos-Esplá


Multi-year, seasonal genotypic surveys of coral-algal symbioses reveal prevalent stability or post-bleaching reversion

Daniel J. Thornhill, Todd C. LaJeunesse, Dustin W. Kemp, William K. Fitt, Gregory W. Schmidt


Recolonisation of Acropora hyacinthus following climate-induced coral bleaching on the Great Barrier Reef


Porites and the Phoenix effect: unprecedented recovery after a mass coral bleaching event at Rangiroa Atoll, French Polynesia

George Roff, Sonia Bejarano, Yves-Marie Bozec, Maggy Nugues, Robert S. Steneck, Peter J. Mumby


Coral gardening in a changing climate: Rapid assessment of the 4th recorded bleaching event at the Anantara Lagoon and reef system, South Male Atoll, Maldives

Abstract: Coral reefs are crucial to marine biodiversity and provide essential ecosystem services, but they face severe threats from climate change, particularly through coral bleaching events. The Maldives, renowned for its diverse coral reefs, has experienced increasing coral bleaching incidents, impacting both marine biodiversity and the tourism-dependent economy. This study investigates the effects of the 2024 coral bleaching event on coral nurseries within the Anantara Lagoon and reef system, South Male Atoll, Maldives. Monitoring was conducted across two coral nurseries in the lagoon and one coral nursery on the natural reef, focusing on species-specific responses to bleaching, predation, and survival rate. Results revealed variability in bleaching impacts among species and locations. Acropora aspera and Acropora muricata exhibited high mortality rates and increased predation, particularly at greater depths (~5 m), while Montipora digitata, Pocillopora damicornis, and Porites cylindrica showed greater resilience. The findings highlight the importance of adaptive management strategies for coral nurseries, emphasizing real-time environmental monitoring and strategic nursery placement to bolster coral reef resilience. This study underscores the need for integrated approaches combining coral restoration with broader reef management practices to enhance ecosystem recovery and sustainability.


Reef development on a remote coral atoll before and after coral bleaching: A geospatial assessment


Widespread coral bleaching in Caribbean


How much time can herbivore protection buy for coral reefs under realistic regimes of hurricanes and coral bleaching?

HELEN J. EDWARDS, IAN A. ELLIOTT, C. MARK EAKIN, AKIYUKI IRIKAWA, JOSHUA S. MADIN, MELANIE MCFIELD, JESSICA A. MORGAN, ROBERT Van WOESIK, PETER J. MUMBY


Hurricanes and coral bleaching linked to changes in coral recruitment in Tobago


Rapid recovery of coral communities from a mass bleaching event in the summer of 2016, observed in Amitori Bay, Iriomote Island, Japan

Masako Nakamura, Tomokazu Murakami, Hiroyoshi Kohno, Akira Mizutani, Shinya Shimokawa

jsps kakenhi, tokai university general research organaization grant


Coral Bleaching and Global Climate Change: Scientific Findings and Policy Recommendations

Jamie K. Reaser, Rafe Pomerance, Peter O. Thomas

Abstract: Abstract: In 1998, tropical sea surface temperatures were the highest on record, topping off a 50‐year trend for some tropical oceans. In the same year, coral reefs around the world suffered the most extensive and severe bleaching ( loss of symbiotic algae) and subsequent mortality on record. These events may not be attributable to local stressors or natural variability alone but were likely induced by an underlying global phenomenon. It is probable that anthropogenic global warming has contributed to the extensive coral bleaching that has occurred simultaneously throughout the reef regions of the world. The geographic extent, increasing frequency, and regional severity of mass bleaching events are an apparent result of a steadily rising baseline of marine temperatures, combined with regionally specific El Niño and La Niña events. The repercussions of the 1998 mass bleaching and mortality events will be far‐reaching. Human populations dependent on reef services face losses of marine biodiversity, fisheries, and shoreline protection. Coral bleaching events may become more frequent and severe as the climate continues to warm, exposing coral reefs to an increasingly hostile environment. This global threat to corals compounds the effects of more localized anthropogenic factors that already place reefs at risk. Significant attention needs to be given to the monitoring of coral reef ecosystems, research on the projected and realized effects of global climate change, and measures to curtail greenhouse gas emissions. Even those reefs with well‐enforced legal protection as marine sanctuaries, or those managed for sustainable use, are threatened by global climate change.


Exhibition of bleaching resistance via adaptive bleaching pattern by coral reefs of the Gulf of Mannar during massive bleaching event 2019

CH. Ramesh, S. Koushik, T. Shunmugaraj, M.V. Ramana Murthy

Abstract: Coral reefs in the Gulf of Mannar (GoM) and Palk Bay regions are facing potential threats from climate change, sedimentation and anthropogenic activities. Considerably, coral reefs in these two regions are highly damaged due to frequent bleaching events caused by increased sea surface temperature (SST) recorded over the past two decades. Recently, during February to May 2019, mass bleaching event of corals was documented again in GoM and Palk Bay regions due to increased sea surface temperatures ranged between 32°C to 36°C. Despite of completely bleached corals, some coral colonies of the same bleached coral species have displayed adaptive bleaching pattern (ABP) for survival. This incidence is displayed by the symbiotic zooxanthellae to protect coral polyps from environmental stress such as elevated temperatures. These observations infer that coral colonies with preferential bleaching pattern ability would serve as environmental stress resisting coral colonies which can be used for restoration activities and cryopreservation. Further studies are needed to explain the potential mechanisms or specific environmental drivers responsible for ABP.


Influence of coral bleaching, coral mortality and conspecific aggression on movement and distribution of coral-dwelling fish

Journal of Experimental Marine Biology and Ecology

Darren J. Coker, Morgan S. Pratchett, Philip L. Munday

Ian Potter Cultural Trust, Centre of Excellence for Coral Reef Studies, Australian Research Council


Coral bleaching––how and why?


Effects of coral bleaching on the feeding response of two species of coral-feeding fish


White but not bleached: photophysiological evidence from white Montastraea cavernosa reveals potential overestimation of coral bleaching

Igor C. S. Cruz, Miguel C. Leal, Carlos R. Mendes, Ruy K. P. Kikuchi, Rui Rosa, Amadeu M. V. M. Soares, João Serôdio, Ricardo Calado, Rui J. M. Rocha


Heating rate modulates the metabolic response of the staghorn coral Acropora cervicornis (Lamarck, 1816)

Harmony A. Martell, Richard C. Zimmerman

Generosity Crowdfunding Campaign, Old Dominion University Biology Graduate Student Organization, Old Dominion University


Commentary: Managing Recovery Resilience in Coral Reefs Against Climate-Induced Bleaching and Hurricanes: A 15 Year Case Study From Bonaire, Dutch Caribbean

Erik H. Meesters, Rolf P. M. Bak, Fleur C. van Duyl


Crown-of-thorns starfish impede the recovery potential of coral reefs following bleaching

M. D. E. Haywood, D. P. Thomson, R. C. Babcock, R. D. Pillans, J. K. Keesing, M. Miller, W. A. Rochester, A. Donovan, R. D. Evans, G. Shedrawi, S. N. Field

Gorgon Barrow Island Net Conservation Benefits Fund


Disturbances in coral reefs: lessons from DIADEMA mass mortality and coral bleaching

OCEANS '88. 'A Partnership of Marine Interests'. Proceedings


Differential Symbiodiniaceae Association With Coral and Coral-Eroding Sponge in a Bleaching Impacted Marginal Coral Reef Environment

Sambhaji Mote, Vishal Gupta, Kalyan De, Afreen Hussain, Kuldeep More, Mandar Nanajkar, Baban Ingole

Abstract: Marginal reefs are known for severe stress-inducible perturbations such as high sedimentation, eutrophication, ocean warming, and acidification from anthropogenic climate change. The corals striving in such stressful environments develop physiological adaptations induced by differential genomic expressions or association with thermal stress-tolerant algal symbionts (Symbiodiniaceae). Despite such adaptations, corals are threatened by other space competitors such as algae and sponges. Coral-eroding sponges belonging to the Cliona viridis complex are one such space competitors that also associate with Symbiodiniaceae algal photosymbiont. The diversity of Symbiodiniaceae associates with the coral and sponge from the same ecosystems is scarcely known. In the present study, Symbiodiniaceae community structure in the coral Turbinaria mesenterina, a newly described coral-eroding sponge Cliona thomasi, and their surrounding seawater was determined from the nearshore marginal reef along the central west coast of India. The results revealed a significantly higher relative abundance of Durusdinium and Gerakladium than Symbiodinium and Cladocopium in the seawater. Interestingly, both investigated host species showed differential Symbiodiniaceae association with significantly higher abundance of Durusdinium in coral and Gerakladium in sponge. The beta diversity analysis by Permutational multivariate analysis of variance (PERMANOVA) confirmed significant differences in Symbiodiniaceae profiles between sponge and coral. Durusdinium and Gerakladium are thermotolerant genera known to associate with different hosts in suboptimal conditions. Our field surveys suggested the bleaching resistance of the coral T. mesenterina despite the fact that the sea surface temperature reached the coral thermal threshold of 31°C during different periods of the years 2015, 2016, 2017, 2018, and 2019. Therefore, the thermal tolerance of the investigated coral and sponge species may be attributed to their respective thermotolerant photosymbiont associations. Furthermore, the results also indicated the host-specific photosymbiont selection from the local environment. Although these observations provide valuable biological insight, more research is needed to understand the tripartite association of sponge-coral-symbiont together to evaluate the competitive fitness of holobionts.


Optimized spatial and temporal pattern for coral bleaching heat stress alerts for China's coral reefs

Xiuling Zuo, Binni Qin, Juncan Teng, Xiaopeng Duan, Kefu Yu, Fenzhen Su


Coral Recruitment and Regeneration on a Maldivian Reef 21 Months after the Coral Bleaching Event of 1998

Karen Loch, Wolfgang Loch, Helmut Schuhmacher, Wolf R. See

Abstract: Abstract. This paper describes the quantitative inventory of stony corals on a Maldivian reef after the bleaching event of 1998. The detailed data, collected in March 1999 and March 2000, comprise survival, new recruitment and regenerates. They were obtained in 6 transects laid out randomly on the reef flat, on 22 Acropora tables on 6 sites at the reef edge and on 39 Porites lobata blocks and 1 Diploastrea heliopora colony. The present cover of living zooxanthellate corals is reduced to ca. 2 – 5 % of its previous state. Acroporidae and Pocilloporidae were practically wiped out, while Poritidae survived partly and Agariciidae (esp. Pavona) are now the dominant group. New settlements on dead Acropora tables were mainly Agariciidae, followed by Acroporidae and Pocilloporidae. Regenerates on Porites were pronounced and the apparent yearly increase in mass was about threefold that of Diploastrea, which is 3 – 4 mm per year. The influence on reef ecology in terms of coral substrate and species, possible sources of larvae, change of guilds in reef builders, other species and the prospect for further development of the reef, with respect to growth versus erosion, is discussed.


Diverse symbiont bleaching responses are evident from 2-degree heating week bleaching conditions as thermal stress intensifies in coral

Sarah Gierz, Tracy D. Ainsworth, William Leggat

AAustralian Research Council Centre of Excellence for Coral Reef Studies, James Cook University, Townsville, Qld 4810, Australia.

Abstract: Coral bleaching is the dysfunction of the coral–algal endosymbiosis and is characterised as a loss of Symbiodiniaceae cells from host tissues or the loss of photosynthetic pigments. This breakdown of symbiosis occurs as a result of elevated temperature beyond the organism’s thermal threshold. The thermal tipping points within the symbiosis have not yet been well resolved, and the mechanisms underlying the various cellular processes of the corals bleaching response remain unknown. This study characterised the cellular responses of the symbiont Cladocopium sp. (syn. clade C3) within the host coral Acropora aspera during exposure to thermal stress. Exposure to temperatures between 2 and 3°C below the bleaching threshold, equating to 2-degree heating weeks (DHWs), results in changes to the symbiont cell morphology and cell division rates. Once corals were exposed to 4 DHWs, over 90% of the symbiont cells showed signs of degradation. Although sub-bleaching thermal stress is not sufficient to trigger bleaching alerts at an ecological scale, this stressor substantially affects the coral symbiosis. It is therefore vital that we begin to quantify how sub-bleaching thermal stress affects the fitness of Symbiodiniacea populations, their coral hosts and subsequently reefs worldwide.


Bleaching Damage and Recovery Potential of Maldivian Coral Reefs


Structural Climate Drivers of Global Coral Bleaching

Jungang Lu, Wenqi Xing, Huazhu Zheng, Zhengyu Yao, Nian Wei, Hongming He

State Key Laboratory of Estuarine and Coastal Research East China Normal University  Shanghai China

National Natural Science Foundation of China

Abstract: ABSTRACT Mass coral bleaching has become a hallmark ecological signature of anthropogenic climate change, yet the structural mechanisms governing its spatial and temporal evolution remain poorly resolved. Traditional assessments emphasize surface thermal anomalies and strong El Niño phases but increasingly fail to explain the persistence of bleaching, its regional asymmetry, and the instability of ecological thresholds. Here, using long‐term datasets (1993–2020) of ocean temperature, bleaching alerts, El Niño–Southern Oscillation (ENSO) indices, coral–algal cover, and subsurface thermal profiles, we identify a regime shift from episodic bleaching toward chronic thermal exposure. This shift reflects a reduced dependence of bleaching on ENSO intensity, as even moderate ENSO phases, including both El Niño and La Niña events, are now associated with widespread bleaching, suggesting progressive erosion of thermal thresholds under sustained ocean warming. We further propose a “Structure–Pathway–Response” framework to capture the structural reconfiguration of bleaching risk: (i) heat convergence along eastern continental margins (e.g., East Asian Seas, Caribbean); (ii) poleward transport and topographic retention of subsurface heat along continental slopes; and (iii) vertical accumulation through isotherm deepening that elevates bleaching risk. We identify two dominant heat‐retention regimes: a current‐deflection mode in the Northern Hemisphere and a thermal‐stacking mode in the Southern Hemisphere. These patterns increase regional vulnerability by broadening the spatial extent and persistence of thermal anomalies, reflecting processes not fully captured by surface Sea Surface Temperature (SST) variability. Our findings highlight the limitations of surface‐only monitoring systems and underscore the need for thermodynamically informed, region‐specific early‐warning frameworks. Protecting structural thermal refugia and managing heat pathways will be critical for sustaining coral reef resilience in a rapidly warming ocean.


Experimental Bleaching of a Reef-Building Coral Using a Simplified Recirculating Laboratory Exposure System

Mace G. Barron, Cheryl J. McGill, Lee A. Courtney, Dragoslav T. Marcovich

Gulf Ecology Division, National Health and Environmental Effects Research Laboratory, United States Environmental Protection Agency, 1 Sabine Island Drive, Gulf Breeze, FL 32561, USA

Abstract: Determining stressor-response relationships in reef building corals continues to be a critical research need due to global declines in coral reef ecosystems and projected declines for the future. A simplified recirculating coral exposure system was coupled to a solar simulator to allow laboratory testing of a diversity of species and morphologies of reef building corals under ecologically relevant conditions of temperature and solar radiation. Combinations of lamps and attenuating filters allowed for assignment of solar radiation treatments in experimental bleaching studies. Three bleaching experiments were performed using the reef building coral,Pocillopora damicornis, to assess the reproducibility of system performance and coral responses under control and stress conditions. Experiments showed consistent temperature- and solar radiation dependent-changes in pigment, numbers of symbiotic algae, photosystem II quantum yield, and tissue loss during exposure and recovery. The laboratory exposure system is recommended for use in experimental bleaching studies with reef building corals.


Succession of delayed fluorescence correlated with coral bleaching in the hermatypic coral Acropora tenuis

Ichiro Takeuchi, Daisuke Takaichi, Masakazu Katsumata, Hiroshi Ishibashi

Japan Society for the Promotion of Science