bluuebunny/crossref_metadata_2025 huggingface dataset:
P785Unplanned readmissions after discharge increases risk of death in acute dyspnoea patients: non-cardiac is as severe as cardiac causes
Authors: Cerlinskaite K , Mebazaa A , Cinotti R , Wussler D N , Gayat E , Juknevicius V , Muller C , Kavoliuniene A , Celutkiene J
Published: October 2019

Introduction

Acute dyspnoea is a major reason for admission to the emergency department and has been associated with high rates of readmission and mortality. However, the association of readmission with mortality risk has not been widely studied in patients with acute dyspnoea.

Purpose

To determine whether unplanned readmission during first 6 months after discharge is associated with greater risk of death within 1 year in patients with acute dyspnoea.

Methods

Derivation cohort consisted of 1371 patients from the prospective observational study, which enrolled acute dyspnoea patients admitted to emergency departments of two university centres from 2015 to 2017 and discharged alive from the hospital. Cox regression analysis compared 1-year risk of death between readmitted vs. non-readmitted patients in the first 6 months after discharge. In addition, we studied this association in 1986 patients from a multicentre validation cohort, which included acute dyspnoea patients from 2006 to 2014. Sensitivity analysis was done in the subgroups divided by cause of index admission (acute heart failure [AHF] and non-AHF) and cause of the first readmission (cardiovascular [CV] or non-CV). The statistical analyses were performed using R statistical software. P value of <0.05 was considered statistically significant.

Results

In the derivation cohort 666 (49%) of patients were readmitted at 6 months and 282 (21%) died in 1 year. Readmitted patients died more frequently than non-readmitted patients (211 [32%] vs. 71 [10%], respectively, p<0.001). All-cause 6-month readmission was associated with an increased 1-year risk of death in a multivariate analysis in both the derivation cohort (adjusted hazard ratio (aHR) 3 [95% confidence interval (CI) 2.2–4], p<0.001) and the validation cohort (aHR 1.8 [95% CI 1.4–2.2], p<0.001). Moreover, deleterious effect of readmission on 1-year survival was equally observed in AHF and non-AHF patients, independent of whether the reason of first readmission was cardiovascular or non-CV, in both study cohorts. The results are displayed in Figure 1.

Figure 1. Main results of the study

Conclusions

Our data demonstrates that readmission is associated with a markedly increased risk of death within 1 year in patients presenting to the emergency department with acute dyspnoea. Furthermore, the detrimental relationship between outcomes is similar in non-cardiac and cardiac causes.

Acknowledgement/Funding

The work was supported by the Research Council of Lithuania, grant Nr. MIP-049/2015 and approved by Lithuanian Bioethics Committee, Nr. L-15-01.
P792Cardiac myosin-binding protein C for the diagnosis and long-term prognosis of acute heart failure
Authors: Kozhuharov N , Wussler D , Kaier T , Walter J , Strebel I , Twerenbold R , Marber M , Breidthardt T , Mueller C
Published: October 2019

Background

Cardiac myosin-binding protein C (cMyC) is a novel biomarker quantifying cardiac injury. Its utility for the diagnosis, prognosis, and therapy guidance in acute heart failure (AHF) is unclear.

Methods

In a prospective diagnostic multicentre study, unselected patients presenting with acute dyspnoea to the emergency department were enrolled. cMyC, high-sensitive cardiac troponin T (hs-cTnT), and N-terminal pro-B-type natriuretic peptide (NT-proBNP) plasma concentrations were measured. Two independent cardiologists/internists centrally adjudicated the final diagnosis using all individual patient's information. Co-primary outcome measures were cMyC's: diagnostic safety and efficacy; prognostic accuracy.

Results

Among 1,330 recruited patients, 247 from an AHF substudy were not included in the diagnostic analysis. Accordingly, 548 patients (51%) in this analysis had an adjudicated diagnosis of AHF. For the rapid rule-out of AHF, the cMyC cut-off concentration at 16 ng/L achieved a sensitivity of 95% (95% CI, 93–97%), a negative predictive value of 88% (95% CI, 84–92%), and allowed to rule-out 21% of the patients. Correspondingly, cMyC's efficacy and safety in the triage of AHF were slightly lower than NT-proBNP's. Of the 790 AHF patients in the prognostic analysis, 222 (28%) died during the 360 days' follow-up. Patients with cMyC plasma concentrations above the median had significantly shorter mean time to death (274 versus 320 days, p=0.001). Compared to hs-cTnT and discharge NT-proBNP, cMyC showed non-inferior prognostic accuracy. No significant interactions between cMyC and cardiac medical therapies at discharge in predicting 360 days survival were present.

Conclusion

cMyC performs well in the rapid triage and prognosis of AHF.

Acknowledgement/Funding

European Union, Swiss National Science Foundation, Swiss Heart Foundation, Cardiovascular Research Foundation Basel, University Hospital of Basel
P800Proposal of an algorithm for the diagnosis of hypertension by using out-of-office blood pressure measurements
Authors: Rhee M Y , Kim J H , Namgung J , Lee S Y , Cho D K , Choi T Y , Kim S Y
Published: October 2019

Background and purpose

Based on the data of patients who measured office BP (OBP) in controlled condition, home BP (HBP), and 24-hour ambulatory BP (24hABP) for diagnosis of hypertension, we developed and validated a diagnostic algorithm for hypertension.

Methods

Patients who have high BP (≥140/90 mmHg) at the outpatient clinic were referred to measure OBP in controlled condition, HBP and 24hABP. The OBP was measured three times at each visit for 3 days in controlled condition by using a validated oscillometric device. HBP was measured for 7 days in triplicates every morning and evening. The 24hABP was measured on the 8th day. Same study protocol was used for development and validation population.

Results

In the development of algorithm, 319 patients were recruited and data of 256 patients (51.8±9.7 years, 119 men) with valid HBP and 24hABP measurements were analyzed. In the validation of algorithm, 300 patients were recruited and data of 257 patients (52.4±9.8 years, 126 men) with valid HBP and 24hABP measurements were analyzed. In the development population, the prevalence of masked hypertension was 19.5% (n=50) and most of them (n=47, 94%) was in the range of 130–139/80–89 mmHg. The BP in the range of 130–144/80–94 mmHg was defined as the grey zone of OBP, because prevalence of white-coat hypertension was lowered to 1.6% from 4.3% with threshold of 145/95 mmHg. The diagnostic sensitivity, specificity, positive and negative predictive value of OBP was improved to 97.4%, 76.5, 96.5% and 81.3% after excluding the grey zone of OBP (n=125). The diagnostic agreement between 24hABP and HBP in the grey zone of OBP was 64%. The diagnostic sensitivity, specificity, positive and negative predictive value of HBP were 88.8%, 74.7, 93.5% and 61.5% after excluding the grey zone of HBP (130–134/80–84 mmHg, n=28). Based upon these results, we developed a diagnostic algorithm for hypertension by using on out-of-office BP measurements to improved diagnostic accuracy of hypertension (Figure). In the validation population, the developed algorithm showed similar diagnostic accuracy.

Diagnostic algorithm for hypertension

Conclusion

For accurate diagnosis of hypertension, OBP measurement according to guidelines and 24hABP measurement to grey zone of OBP is preferred. To improve diagnostic accuracy of HBP measurement, 24hABP measurement to grey zone of HBP is required.

Acknowledgement/Funding

Part of this study was supported by a grand from Dong-A ST Co. Ltd., Seoul, Korea.
P801Continuous cuff-less blood pressure monitoring using vascular elasticity model on photoplethysmogram
Authors: Lin T T L , Guo H W G , Lee H F L , Su P Y S
Published: October 2019

Background

Hypertension is a well-known risk factor for potentially cardiovascular diseases, which is underdiagnosis and treatment. Clinical evidence suggests that periodic and continuous monitoring of blood pressure (BP) is helpful for the early detection of hypertension to reduce the cardiovascular risk. Photoplethysmogram (PPG) is a simple and non-invasive technique to measure the instantaneous blood flow in capillaries. This study proposes a miniaturized PPG sensor, which is feasible to integrate into smartphone, to estimate cuff-less BP and heart rate (HR).

Methods

A miniaturized PPG sensor, provided by FocalTech Smart Sensors Co., Ltd., was used to collect reflective finger PPG signal. The methodology of BP estimation from PPG was using a vascular elasticity model which estimating the physiological parameters from PPG features Simultaneously, we utilized oscillometric blood pressure monitors to obtain automated BP readings as the validation standard.

Result

Seventy-one subjects were recruited in this validation study. By using our PPG algorithm, an accuracy of ± 11.9 mmHg for systolic BP and ± 8.0 mmHg for diastolicBP was observed at 71 subjects. There was a good linear correlation (CC) between PPG-estimating BP and automated BP (systolic BP, CC=0.4; diastolic BP, CC=0/.45).Likewise, slopes of the liner fit on the Bland Altman plots for both systolic BP (slope = −0.23) and diastolic BP (slope = −0.11) indicated there was no particular bias in predicting high or low BP.

Subjects characteristics Parameters Total number (subjects) 71 Entry BP range Normal 21 Prehypertension 27 Stage 1 hypertension 17 Stage 2 hypertension 6 Sex Male 37 Female 34 Age (years) Mean ± standard deviation 55±12 Range 27–77

Conclusion

In this study, the feasibility of mobile based cuff-less BP measurement using a vascular elasticity model on finger PPG signal was demonstrated with a level of acceptable accuracy. Based on mobile-based and easy-to-use features of our sensor/device, the incorporation this real-time measurement into the monitoring of BP could be helpful for the management of hypertension.
P808Characteristics of patients with reproducible masked hypertension
Authors: Smirnova M I , Gorbunov V M , Volkov D A , Koshelyaevskaya Y N , Deev A D , Furman N V , Dolotovskaya P V
Published: October 2019

Background

Masked hypertension (MH) is associated with cardiovascular complications and poor prognosis. Characteristics of untreated patients with reproducible MH are studied insufficiently.

Purpose

The aim of our study was to assess characteristics of ambulatory patients with reproducible MH in comparison to patients with non-reproducible MH in two visits.

Methods

The patients from the ambulatory BP monitoring (ABPM) database (>2000 patients) were selected according to the following criteria: absence of any antihypertensive treatment (AHT), availability of clinical BP (CBP) and ABPM records at two visits with the 6 months interval, CBP<140 and 90 mmHg at both visits, availability of clinical, anthropometric data and history. MH criteria in each patients should be present at least at one of the visits. ABPM was performed by the oscillometric device equipped with software for arterial stiffness calculation. The standard statistical methods and analysis of variance (ANOVA) were used.

Results

We selected 295 patients (men 43%, mean age 49.0±7.6 years, CBP 128.4±9.4/80.5±7.2 mm Hg, body mass index 27.6±4.3 kg/m2, 24h pulse wave velocity in aorta [PWV] 10.7±1.7 m/s). MH only at one visit was found in 168 patients (56.9%). Respectively, MH at both visits was in 127 patients (43.1%). The patients with reproducible MH were characterized by the presence of: mother's (p=0.011) or father's hypertension (p=0.025), mother's ischemic heart disease (p=0.015), mother's myocardial infarction (p=0.020), father's stroke (p=0.030), higher arterial stiffness (PWV 11.0±1.7 m/s vs. 10.5±1.8 m/s, p=0.022), and systolic BP in aorta (120.0±7.5 mmHg vs. 117.8±9.4 mm Hg).

Conclusions

The patients with reproducible MH (without AHT) are characterized most of all by the family history of hypertension and its complications. The correlation of stable MH with arterial stiffness confirms the importance of PWV and central aortic pressure measurement in patients with CBP<140 and 90 mmHg.
P822Statin treatment in symptomatic patients with non-obstructive coronary artery disease reduces the risk of all-cause mortality
Authors: Kissel C K , Chen G , Fung M , Wilton S B , Anderson T J
Published: October 2019

Introduction

Symptomatic patients with non-obstructive coronary artery disease (NOCAD; stenosis >0% <50%) have a worse prognosis and an increased risk for all-cause mortality compared with age-matched controls. Currently, treatment of these patients is empiric, and secondary preventive measures are less often implemented. The goal of the study was to examine whether statin prescription has an impact on all-cause mortality in symptomatic NOCAD patients, and which factors influence statin prescription in patients with NOCAD.

Methods

We examined 4039 symptomatic patients who presented either with stable angina (SA) or an acute coronary syndrome (ACS) who underwent coronary angiography; 1582 had angiographically normal coronary arteries, 2457 had minimal disease (NOCAD). The comparison group consisted of 2998 patients with stable obstructive CAD (stenosis ≥50%). Patients had at least one lipid panel tested between April 1, 2010 to March 31, 2014. We examined the rate of statin prescription amongst the groups, as well as predictors of all-cause mortality and statin treatment.

Results

Symptomatic patients with NOCAD are less likely to receive statin therapy (60.4%) compared to patients with obstructive CAD (87.3%). After one, three and five year(s), LDL levels in NOCAD patients are higher than in CAD patients (2.21±0.88mmol/l vs. 1.84mmol/l±0.77mmol/l after 1 year). Statin treatment was associated with a significantly lower risk of all-cause mortality in NOCAD (HR 0.64 (0.44–0.95)), as well as in CAD (HR 0.44 (0.31–0.62)), but not in patients with normal coronaries HR 0.55 (0.27–1.15)). Sex, age and the presence of other cardiovascular risk factors influenced the prescription of statin therapy in the first 5 years after initial diagnosis of NOCAD- older patients with diabetes and hypertension were more likely to receive statin therapy. Women received statin therapy to a lower percentage than men in the NOCAD group (year 1: men 62.9% vs, women 56.9%; p=0.003). No effect of cardiovascular risk factors, age or sex on statin prescription was seen in the CAD group or patients with normal coronaries.

Conclusion

Statin therapy reduces the risk of all-cause mortality in symptomatic patients with NOCAD. In spite of this benefit, patients with NOCAD, and especially women, are less likely to receive secondary-preventive statin therapy.
P825Long-term clinical benefit of atorvastatin pretreatment before primary percutaneous coronary intervention in patients with STEMI: a multi-center propensity score-matched study
Authors: Yang J G , Gao P , Chen T G , Li X , Xu H Y , Gao X J , Yang Y J
Published: October 2019

Aims

We aim to investigate the effect of single dose of statin pretreatment prior to primary Percutaneous Coronary Intervention (PCI) on long-term clinical outcomes in patients with ST-elevation Myocardial Infarction (STEMI).

Methods

Using data from China Acute myocardial Infarction (CAMI) registry, we compared the outcome in STEMI patients with vs without atorvastation pretreatment prior to primary PCI. The primary endpoint was the composite outcome of all-cause mortality, non-fatal MI or stroke events during follow-up. Propensity-score (PS) matching was used to assemble a cohort of patients with similar baseline characteristics. All patients were followed till 24 months since baseline.

Results

Of all 3772 patients who met our inclusion criteria at 108 hospitals in China, 3288 patients (1644 patients in each arm) were included in our PS-matched cohort. In the PS-match cohort, overall 144 (8.65%) and 113 (6.79%) patients in the control group and pretreatment group had the primary endpoint respectively (p=0.048). The estimated HRs were 0.78 (95% CI: 0.606–0.997, p=0.046) in the unadjusted model and 0.76 (95% CI: 0.596–0.984, p=0.032) in the adjusted model (Figure). The HRs were broadly similar for the pretreatment dosage of 40 mg or 80 mg (0.78 vs 0.77, p=0.75). The HRs were even stronger in patients with single-vessel only than multi-vessel coronary artery disease (0.31 vs 0.75, p=0.014).

Conclusion

Among Chinese patients with STEMI, atorvastatin pretreatment before primary PCI may have better long-term composite outcome of all-cause mortality, non-fatal MI, or stroke events.

Acknowledgement/Funding

CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)
P826Peri-procedural treatment with high dose Rosuvastatin reduces soluble TNF receptor 1 in patients treated with primary percutaneous coronary intervention for ST elevation myocardial infarction
Authors: Larsen A I , Butt N , Aukrust P , Munk P S , Nilsen J M , Orn S , Ueland T
Published: October 2019

Background

The extent of cardiac injury in ST elevation myocardial infarction (STEMI) depends on the level of inflammation and subsequent immune cell recruitment. An inflammatory phase that is disproportionately prolonged, of excessive magnitude, or insufficiently suppressed, can lead to sustained tissue damage and improper healing, promoting infarct expansion, adverse remodelling and chamber dilatation. Soluble TNF receptor 1 (sTNFR-1) is believed to mirror systemic pan-inflammatory status more closely than a single cytokine antigenic level. sTNFR-1 levels might give prognostic information, independent from and, at the same time, additive with some well-recognized outcome predictors such as left ventricular ejection fraction.

Purpose

We hypothesised that sTNFR-1 and other inflammatory markers could be modulated by statins.

Methods

Plasma levels of inflammatory markers were measured at baseline, 2 days, 7 days and 2 months in consecutive patients with first time STEMI with single vessel disease. Twenty-five patients (treatment group (TG)) were treated with 80 mg Rosuvastatin daily with first dose before primary percutaneous coronary intervention (PCI) whereas the control group (CG) consisted of 34 patients in whom treatment with 20 mg simvastatin daily were initiated the day after PPCI.

Results

sTNFR1 increased during the first 48 hours following PCI and this increase was larger in the CG compared with the TG (0.22±0.30 ng/mL vs 0.08±0.19 ng/nmL, p=0.025). The difference in increase during one week was only borderline statistically significant (0.21±0.30 ng/mL vs 0.08±0.26 ng/mL, p=0.081). These differences in the kinetics of sTNRF-1 were mirrored by changes in Pentraxin 3 (PTX3) between groups from baseline to 1 week, CG vs TG. (0.28±0.70 μmol/l vs 0.10±0.05 ng/mL, p=0.014) and at 2 months (−0.42±0.56 ng/mL vs 0.08±0.60 μmol/l, p=0.032)

Conclusion

High dose Rosuvastatin therapy initiated peri-procedural during PPCI for STEMI reduces pan inflammation as reflected by sTNFR1 and is associated with a less abrupt fall in PTX3 at 1 week and 2 months supporting recent research suggesting that PTX3 plays a cardiovascular protective effect in cardiovascular disease and healing.

Acknowledgement/Funding

Western Norway Regional Health Authority
P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI
Authors: Mehmedbegovic Z , Milasinovic D , Jelic D , Zobenica V , Dedovic V , Radomirovic M , Zaharijev S , Pavlovic A , Dudic J , Tesic M , Zivkovic M , Veljic I , Asanin M , Vukcevic V , Stankovic G
Published: October 2019

Background

Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models.

Purpose

We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI.

ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.

Results

Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1):

Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC <0.05 0.75 0.74–0.77 vs. TIMI <0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI <0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI <0.01 0.81 0.80–0.83 vs. ZWOLLE <0.000 vs. TIMI <0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE <0.000 vs. TIMI <0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78

Figure 1

Conclusion

Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.
P865Mechanical Complications in ST elevation myocardial infarction: Trends in prevalence, acute phase prognosis and one-year mortality after the onset of reperfusion network
Authors: El Ouaddi N , Garcia-Garcia C , De Diego O , Labata C , Rueda F , Oliveras T , Camara M L , Serra J , Berastegui E , Ferrer M , Munoz C , Bayes-Genis A
Published: October 2019

Background

The development of mechanical complications (MC) following an ST elevation myocardial infarction (STEMI) is associated with a high acute phase and long-term mortality. However, the widespread use of reperfusion therapies with primary angioplasty (pPCI) and surgical management could have reduced the prevalence of MC and improved the prognosis of these patients in the last years.

Purpose

The aim is to analyze the changes in the prevalence, management and acute phase prognosis and 1-year mortality of STEMI patients complicated with MC between two periods, before and after the onset of pPCI reperfusion network.

Method

We included all STEMI patients in a single centre prospective registry. Between 1990 and 2000, 2,251 STEMI patients were consecutively admitted in the Coronary Care Unit of a University Hospital (pre-pPCI period). In 2007, pPCI reperfusion program was onset in our centre. Between 2007 and 2017, 3,783 consecutive STEMI patients were included in the registry (post-pCI period). We analyze the prevalence of MC, management (reperfusion therapies, surgery ...) and 28-day and 1-year mortality among these two periods.

Results

A total of 6,034 STEMI patients were included in the registry (men 78.8%, mean age 61.7 years, SD 12.8). Patients admitted in the post-PCI period were older (62.4 vs 60.4 years, p<0.001) and have more prevalence of hypertension and dyslipidemia. Reperfusion therapy increased in post-pPCI period (89.1% vs 49.7%, p<0.001), due to widespread use of pPCI. A total of 105 patients (1.7%) develop any mechanical complication: 35 with ventricular septal rupture (VSR), 22 with papillary muscle rupture (PMR) and 48 patients with free wall rupture (FWR). Prevalence of MC has not been change between both periods. VSR occurred in 0.6% pre-PCI and 0.6% post-pPCI, p=0.98; PMR 0.3% vs 0.4% post-PCI, p=0.33; and FWR 1% vs 0.7% post-PCI, p=0.22). Overall 28-day STEMI mortality has been reduced in post-pPCI period (5.9% vs 10.1%, p<0.001 in acute phase). This 28-day mortality remains very high and without significant changes when MC appears: VSR: post-pPCI 77.3% vs 58.0%, p=0.25; PMR: 25.0% post-PCI vs 58.3%, p=0.69; and FWR: 66.4% post-PCI vs 73.7%, p=0.84). One-year mortality has not been changed between both periods and stays in a very high ratio (65.7% for VRS, 45.4% for PMR and 66.7% for FWR).

Conclusions

Although reperfusion therapy greatly increased with the onset of a pPCI reperfusion network, prevalence of MC has not been change over three decades in our series. Acute phase (28-day) and one-year mortality remains very high and without significant reduction in post-pPCI period.
P874Role of Genetic Polymorphisms of ion channels in the pathophysiology of coronary microvascular dysfunction and ischemic heart disease: an update
Authors: Pucci M , Severino P , D'Amato A , Netti L , Scarpati R , Infusino F , Cimino S , Mariani M V , Maestrini V , Palmirotta R , Mancone M , Fedele F
Published: October 2019

Background

Ischemic heart disease (IHD) is classically associated with coronary artery disease (CAD) and conventional cardiovascular risk factors. However, IHD may exhibit in the absence of CAD, because of different pathophysiological mechanisms, such as the presence of specific genetic variants of ion channels, which act mainly in the microcirculation. Recently, we reported the correlation between some single nucleotide polymorphisms (SNPs) of ion channels genes and the presence of IHD, independently from the presence of conventional cardiovascular risk factors. The goal of this study is to confirm the results of the previous study on a bigger population and discover new SNPs of ion channels genes which may be associated with IHD.

Methods

A prospective, observational, single-center study was conducted on patients candidates for coronary angiography. Patients were divided in three groups: G1, coronary artery disease; G2, microvascular disfunction; G3, normal. Genetic polymorphisms relative to KCNJ11 encoding for the Kir6.1 and Kir6.2 subunits of K-ATP channels and KCNE1 encoding for the MinK subunit of IKs channels were analyzed.

Results

603 consecutive patients (G1: 409; G2:76; G3:118) were enrolled. Genetic analysis for the three groups showed a statistically significant difference for the SNP S38G of KCNE1 (p=0.001) and for the variants rs5215, rs5218, rs5219 of KCNJ11 (p<0.0001), as well as comparing G1-G3 (S38G p=0.006; rs5215, rs5218 and rs5219 p<0.0001). Regarding G1-G2 we confirmed differences only for the variants rs5215 (p<0.0001), rs5218 (p=0.005) and rs5219 (p=0.024), while regarding G2-G3 we found differences for the variants S38G, rs5215 e rs5219 (p<0.0001). A multivariate analysis was performed and highlighted that the SNP rs5215_GG of KCNJ11 may represent an IHD independent protective factor (p<0.0001; OR: 0.036; 95.0% CI: 0.018–0.069).

Conclusion

These results confirm the importance of genetic susceptibility and the role of SNPs of ion channels genes in the determinism of IHD, independently from the conventional cardiovascular risk factors. Moreover, these results may represent a future perspective for a genic therapy for IHD.
P881Differences during admission in patients with myocardial infarction with non-obstructive coronary arteries compared to myocardial infarction with obstructive lesions
Authors: Alcon Duran B , Lopez Pais J , Galan Gil D , Izquierdo Coronel B , Espinosa Pascual M J , Fraile Sanz A , Awamleh Garcia P , Moreno Vinues C , Alonso Martin J J
Published: October 2019

Introduction

Myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA) means a non-negligible proportion of patients (pts) admitted for MI. However, there are still unsolved questions about this entity. The aim of our study is to analyse the differences between the MINOCA group compared with pts admitted for MI with obstructive coronary disease.

Method

Analytical and observational study developed in a Universitary Hospital, which covers 220.000 individuals. From january-2016 until december-2018 we reviewed all the pts that were admitted for MI who underwent coronariography. MINOCA pts (defined according 2016 ESC Working Group position paper) compared with MI pts with obstructive lesions.

Results

One hundred and nine from 521 pts admitted for MI in whom a coronariography was performed fulfilled the 2016 ESC criteria of MINOCA (20%). Clinical presentation showed no difference in Killip-Kimball classification (K-K > I was 6.1% in MI with obstructive lesions vs 6.5% in MINOCA pts, p 0.897). Chest pain (Angina) was more frequent in MI with obstructive lesions (82.8% vs 73.4%, p 0.027) and they also had more ST changes (ST elevation 41% vs 24%, p 0.001; ST descent 17% vs 8.3%, p 0.026). MINOCA pts had lower levels of troponine (troponine elevation less than 10 times the 99th percentile: 10.4% vs 26.6%, p<0.001). Left ventricular systolic dysfunction showed no difference neither in the % of pts with ejection fraction lower than 50% (MI with obstructive lesions: 32% vs MINOCA: 34.3%, p 0.659) nor in severe systolic dysfunction (ejection fraction lower than 30%: 4.9% in MI with obstructive lesions vs 7.4% in MINOCA pts, p 0.313). The average stay in MI pts with obstructive lesions was 12.6 days vs 8.9 days in MINOCA pts (p 0.274). Complications during hospital admission occurred in 17.6% of obstructive pts and in 13.8% of MINOCA pts (p 0.335). Only one MINOCA pts (0.9) died during admission compared to 3.4% of MI pts with obstructive lesions, being this result statistically non significant (p 0.213).

Conclusions

Although MINOCA pts have lower troponine levels and less severe alterations on the EKG, we did not find differences regarding left ventricular function and the rate of complications with hospital mortality that tended to be higher in patients with obstructive lesions.
P882Predictors of myocardial infarction with non-obstructive coronary arteries (MINOCA)
Authors: Espinosa Pascual M J , Lopez Pais J , Izquierdo Coronel B , Galan Gil D , Alcon Duran B , Awamleh Garcia P , Moreno Vinues C , Gorriz Magana J , Fraile Sanz A , Alonso Martin J J
Published: October 2019

Introduction

Increasing knowledge about MINOCA can improve its diagnosis and treatment. The aim of this study is to determine the predictors of MINOCA in the initial assessment of myocardial infarction (MI).

Methods

From 1 January 2016 to 31 December 2018, we carried out an analytical and observational study including all patients admitted to our hospital with MI and underwent coronary angiography. According to the definitions of 2016 ESC Position Paper on MINOCA, we classified the patients in two groups: infarction with obstructive coronary artery disease (MICAD) and MINOCA. We analyzed demographic, clinical, laboratorial and angiographic features. To determine MINOCA independent predictors, a multivariate analysis with logistic regression was carried out in those variables with a statistical signification lower than p<0.01 in the univariate analysis.

Results

During this 3-year period, 109 patients admitted with MI fully fit the 2016 ESC criteria of MINOCA. The table shows the results regarding our findings. Patients with MINOCA compared to those with MICAD, were younger and with fewer risk factors. Moreover MINOCA was found to be more frequent in women than men. More specifically, MINOCA patients more frequently had a previous history of psychiatric illnesses. They also suffered from higher stress levels either acute or chronic. Inflammatory condition rates were more than two-times higher in the MINOCA group and presented lower levels of troponine. After multivariate analysis, only female patients, inflammatory disorders, stress levels, and lower levels of hemoglobin and troponine, remained independent predictors of MINOCA.

Univariate analysis Multivariate analysis MINOCA MICAD P Odds Ratio 95% CI P Female patients 51,4% 21,8% <0.01 2.1 1.12–4.09 0.021 Smokers 41.9% 69.2% <0.01 0.5 0.3–1.02 0.059 Psychiatric disease 22.9% 10.7% <0.01 0.97 0.45–2.08 0.952 Emotional stress 65.9% 34.5% <0.01 3.4 1.81–6.36 <0.01 Autoimmune disorders 34.9% 14.1% <0.01 2.73 1.45–5.1 0.002 Heart rate at admission (lpm) 89±27.1 79±17.7 <0.01 1.92 0.95–3.86 0.068 Troponine I peak (ng/ml) 5.52±8.8 34.05±61.8 <0.01 2.32 1.16–4.65 0.017 Hb (g/dl) 13.5±2.13 14.17±1.83 0.03 2.89 1.48–5.6 0.02

Conclusion

MINOCA patients differ in some ways to those patients with MICAD. Being a woman, recognizing emotional stress, having autoimmune disorders and lower levels of troponine and Hb might predict having a MINOCA.
P886Exercise left ventricular outflow track obstruction in hypertrophic cardiomyopathy: peak exercise or post-exercise pressure gradients?
Authors: Nahmani Y , Hammoudi N , Huang F , Bouziri N , Pousset F , Maupain C , Charron P , Isnard R
Published: October 2019

Background

Left ventricular outflow track obstruction (LVOTO) is a key feature of hypertrophic cardiomyopathy (HCM), associated with poor prognosis and requiring specific management in symptomatic patients. Furthermore, new drugs targeting LVOTO are under investigation. Exercise echocardiography is the more relevant test to unmask latent obstruction in patients with HCM and to link obstruction to symptoms during physical activity. However, little is known about the role and impact of obstruction according to the precise time of occurrence during exercise or immediate recovery.

Objective

We hypothesized that LVOT pressure gradients could be enhanced during immediate recovery after exercise compared to peak exercise in patients with HCM.

Methods

We conducted an observational, single center and retrospective study and included all the patients with HCM referred to our department between 2010 and 2018 for an exercise echocardiography. All exercises were performed on a bicycle in a semi-supine position and LVOT pressure gradient were recorded continuously during and immediately after exercise in the same position.

Results

121 patients with HCM were included (age 49±16 y, 64% male, 59% NYHA 2 and 3, LV ejection fraction 66±7%, max LV wall thickness 19±5 mm, 69% receiving betablockers). Exercise was performed until exhaustion at a mean workload of 118±58 Watts. Overall, the maximal LVOT gradients increased from rest, to peak exercise and recovery (respectively 17±18, 39±43 and 55±60 mmHg, p<0,0001). More than half of the patients (52%) had a gradient ≥30 mmHg at least in one phase, but a maximal gradient ≥50 mmHg (threshold for invasive treatment in symptomatic patients) was observed in only 7% of the population at rest, 25% at peak exercise and 37% at recovery (p<0.001). Finally, a maximal gradient ≥50 mmHg was recorded only during immediate recovery (69±25 mmHg) and not during exercise in 16 patients (13%). None of them experienced post-exercise syncope.

Conclusion

The time course of significant LVOTO during exercise in HCM should be evaluated carefully. LVOTO is more severe and more prevalent during immediate recovery. Some patients exhibit only significant post-exercise LVOT pressure gradients, which therefore cannot explain limitation during exercise.
P887Atrial fibrillation is associated with sudden cardiac death risk factors in patients with hypertrophic cardiomyopathy
Authors: Marcuschamer I A , Zusman O , Schwartzenberg S , Vaturi M , Shapira Y , Kornowski R , Sagie A , Monakier D
Published: October 2019

Background

Atrial Fibrillation (AF) is prevalent in a fourth of patients with Hypertrophic Cardiomyopathy (HCM), but its clinical impact in these patients remains ill-defined.

Aim

To compare clinical characteristics in HCM patients with vs without AF and assess indirectly potential sudden cardiac death (SCD) risk.

Methods

Retrospective study in a single tertiary referral HCM center. Patients with HCM and AF were compared with matched controlled HCM patients without AF. NYHA class was assessed by a single physician. Propensity score matching was performed with a ratio of 2:1 by nearest neighbor with adjustment for age, sex, and left ventricular tract obstruction (LVOTO). Ordinal regression was used with NYHA as outcome.

Results

Among 298 patients with HCM, 68 patients (22.8%) had AF. After propensity matching, 66 patients with AF and 112 without AF had similar distribution of age (67.1 vs. 65.1 years), gender (57.6% vs. 61% males) and Basal Surface Area (1.88 vs. 1.87 m2) respectively. The prevalence of LVOTO (57.6% vs. 58.5%) and apical hypertrophy (19.7% vs 19.5%) was similar in the two groups. Cardiac risk factors including Hypertension (60.6% vs. 60.2%) and Diabetes Mellitus (15.2 vs. 20.3%) were similar in both groups. AF patients were diagnosed with HCM at a younger age than patients without HCM (48.5 vs. 55 years; p=0.01). HCM patients with AF had significantly lower LVOT gradients compared with patients without AF (28.1 mmHg vs 47.4 mmHg, p=0.005), had a higher prevalence of non-sustained ventricular tachycardia (39.4% vs. 9.4%; p<0.01), and ventricular tachycardia (9.1% vs 1.7%; p<0.04) and were more likely to have undergone implantation of an internal cardioverter defibrillator (ICD) (23.1% vs. 8.5%; p=0.001), respectively. Dyspnea was the most prevalent symptom in both groups (51.1% and 46.6% in AF and non-AF respectively). NYHA Class was similar in both groups: 1.88±0.69 in patients with AF vs. 1.73±0.74 in patients without AF (p=0.17). NYHA class did not differ in 26 patients with chronic persistent AF vs. 42 patients with paroxysmal AF (being in sinus rhythm at evaluation).

Conclusion

AF does not seem to impact functional level class in patients with HCM, but carries a higher burden of sudden cardiac death prognostic factors, incurring a higher rate of ICD implantation.

Acknowledgement/Funding

None
P902Danon disease: clinical features and outcomes
Authors: Brambatti M , Esshaki Y , Vanam S , Escobedo V , Macias G , Le B , Bui Q , Ma G , Taylor M , Adler E
Published: October 2019

Background

Danon Disease (DD) is a rare X-linked autophagic vacuolar myopathy, characterized by high penetrance and severe cardiomyopathy; cognitive, skeletal muscle and vision impairment may occur as well. Due to its rarity, clinical presentation and outcomes are still uncertain.

Purpose

To describe clinical features and outcomes of DD in female and male patients

Methods

Individuals and families from United Kingdom, Australia, and United States were recruited through via advertisements on Facebook groups related to DD. Participants completed a survey about symptoms and medical history and provided their medical records to the research team.

Results

A total of 44 patients (54.5% female) with positive genetic testing for DD were included. De novo mutations occurred in one out of four patients. Cardiomyopathy occurred in 86.3% of patients (18/24 females, 20/20 males) at a mean age of 7.3 years for males and 19.4 years for females (p=0.001). Females presented with either hypertrophic cardiomyopathy (HCM, 66.7%) or dilated cardiomyopathy (DCM, 8.3%) whereas males presented with HCM 90% of the time. 34.2% of patients were diagnosed with Wolff-Parkinson-White syndrome.

Twelve patients (7 females, 5 males) underwent cardiac magnetic resonance (CMR) Out of the 9 cases, 8 (88.9%) exhibited extensive patchy late gadolinium-enhancement (LGE) in multiple segments of the left ventricle; 3 cases also had right ventricular LGE. Median cardiac mass index was 155 g/m2 (Q1-Q3: 70–237; v.n. 31–79 g/m2). Overall, 17 (38.6%) patients died or required or heart transplant (HTx). Median age at the time of death or HTx was 17 years and 42 years in males and females, respectively (p=0.025 by the log-rank test)

Cognitive impairment, mainly described as learning disabilities, was diagnosed in 90.0% of males (18/20) and 79.2% (19/24) of females; intelligence quotient (IQ) measurement was reported in 8 patients (3 females, 5 males) and 7 of them showed IQ below the average. Symptomatic skeletal myopathy was present in 28 (63.3%) of patients, with a higher prevalence in males (85% vs. 45.8%; p<0.01). Retinopathy was reported in 14 (31.2%) patients and occurred equally in both genders (p=0.34).

Conclusions

DD causes significant cardiac morbidity with the need for transplant at a young age; in 25% of cases DD is due to a de novo mutation. While in males DD is more frequently multisystemic with a more rapid clinical deterioration, in females the clinical presentation is variable. However, the presence of severe cases in females warrant the clinicians to screen for DD in both sexes with clinical manifestations or positive family history

Acknowledgement/Funding

Rocket Pharmaceuticals
P903Is left ventricular longitudinal strain a good pronostic factor in friedreich ataxia?
Authors: Heuze C , Legrand L , Diallo A , Monin M L , Ewenczyk C , Isnard R , Vicaut E , Durr A , Pousset F
Published: October 2019

Introduction

Friedreich ataxia (FRDA) is a rare genetic sensory ataxia. The causal mutation is an expanded trinucleotide repeat (GAA) in the frataxin gene. Hypertrophic cardiomyopathy is associated with FRDA and is the major cause of early death before 40 years old. Patients with progressive decline of the left ventricular ejection fraction (LVEF) have the worse prognosis. Speckle tracking echography with 2D longitudinal myocardial strain (GLS) is recognized as a more effective technique than conventional LVEF in detecting subtle changes in LV function.

Purpose

Evaluate the prognostic value of global longitudinal strain (GLS) in patients with FRDA as compared to LVEF.

Methods

From 2003 to 2017 consecutive patients with genetically confirmed FRDA were included. Longitudinal strain analysis was retrospectively performed with Tomtec software. News were obtained until April 2018, no patient was lost during follow-up.

Results

The study included 156 patients (51% male) of 35±12 years (mean ± SD) with an age at disease onset of 17±11 years, age at wheelchair use of 26±10 years, and GAA repeat on the shorter allele of 590±241 pb. The following echocardiographic parameters were studied at baseline: LVEF 64±9%, GLS −19.8±5% (n=141), septal wall thickness (SWT) 11.4±2.5 mm, posterior wall thickness (PWT) 10.4±1.8 mm, LV end diastolic diameter (LVEDD) 44.4±6mm. Correlation between GLS and LVEF was 0.31 (p=0.0002).

After a mean follow-up of 7.7±4.0 years, 17 (11%) patients died and the outcome (cardiac arrhythmia, heart failure, stroke or death) concerned 28 (18%) patients. In univariate analysis (Cox model), factors associated with mortality were: GLS (HR: 1.2; 95% CI 1.10–1.32, p=0.0001), LVEF (HR: 0.88; 95% CI 0.85–0.92, p<0.0001), GAA (HR: 1.28; 95% CI 1.11–1.47, p=0.0008), age at onset (HR: 0.84; 95% CI 0.76–0.94, p=0.002), LVMi (HR: 1.02; 95% CI 1.01–1.04, p=0.0078), SWT (HR: 1.18 95% CI 1.01–1.36, p=0.03) and LVEDD (HR: 1.09; 95% CI 1.00–1.19, p=0.04). In multivariate analysis LVEF was the only independent predictor of long-term mortality (HR: 0.93; 95% CI 0.88; 0.99, p=0.02). Similarly GLS was not an independent predictor of the composite outcome in multivariate analysis.

Conclusion

GLS is a predictor of morbimortality but is not superior to LVEF in FRDA patients. Further prospective studies are mandatory to assess the early predictive value of 2D GLS.
P904Heart rhythm and conduction disorders in children with restrictive cardiomyopathy
Authors: Vershinina T L , Yakovleva E V , Gorozhankina E U , Vasichkina E S , Nikitina I L , Pervunina T M , Kostareva A A
Published: October 2019

Introduction

Restrictive cardiomyopathy (RCMP) is characterized by restrictive filling and reduced diastolic volume of either or both ventricles with normal or near-normal systolic function and wall thickness. It may occur idiopathically or as a cardiac manifestation of systemic diseases and various neuromuscular disorders. Often RCMP occurs with severe symptoms of heart failure and has an poor prognosis. Given the presence of structural myocardial abnormalities, atrial dilatation, this group of patients has a high risk of heart rhythm and conduction disturbances.

Objective

To present our clinical experience in RCMP with the heart rhythm and conduction disturbances in children.

Material and methods

The study was approved by the Institute Ethical Review Board. On behalf of the children enrolled in the study, written informed consent was obtained from the next of kin. The study included 18 children with RCMP presented with heart failure class II-IV. The genotyping was performed to all patients. The identified genetic variants were classified according to ACMG guidelines. We analyzed clinical history, data of physical examination, laboratory findings, ECG, echocardiography, Holter monitoring, genetic test, cardiac MRI and CT performed according to clinical indications and physician's.

Results

Mean age of RCMP manifestation was 2,1 y.o. [0–11] with HF as a main clinical feature. Rhythm and conduction disorders were reported in 83% (n=15) of children. The structure of the disorders included: atriventricular block 1–2 degrees in 22% (n=4), supraventricular disorders (extrasystole, tachycardia, atrial fibrillation) in 44% (n=8), ventricular disorders (extrasystole, tachycardia) in 16% of patients (n=3). One patient had a combined rhythm and conduction disorder (sinus sick syndrome, atrial fibrillation, supraventricular and ventricular tachycardia), which required implantation of a pacemaker with a defibrillator function. In one patient, the manifestation of the disease was with hemodynamically significant permanent-recurrent atrial tachycardia. Mortality in this group of patients was 27% (= 5), the cause of death was the progression of heart failure in 3 children and sudden arrhythmial death in 2 patients.

Conclusions

Thus, RCMP is a severe, genetically caused, with early manifestation progressive disease with high risks of rhythm and conduction disturbances, sudden arrhythmial death. According to the testimony, patients should receive antiarrhythmic therapy and, if necessary, pacemaker implantation is indicated.