bluuebunny/crossref_metadata_2025 huggingface dataset:
P6257Low systolic blood pressure on admission as a predictor of outcome in octogenarian patients with heart failure and preserved ejection fraction
Authors: Tsuda K , Kanzaki Y , Maeda D , Akamatsu K , Nakayama S , Horai R , Sakane K , Ozeki T , Fujita S , Fujisaka T , Sohmiya K , Hoshiga M
Published: October 2019

Background

Heart failure (HF) is an epidemic in healthcare worldwide including Asia. It appears that HF will become more serious with aging of the population. The patients with heart failure and preserved ejection fraction (HFpEF) were older, more often female, and frequently have comorbidities including hypertension. However, lower systolic blood pressure (SBP) on admission is associated with poor outcomes in patients with HF. It remains unclear whether this association is similar in very elderly patients with HFpEF.

Purpose

To investigate clinical features and prognosis in octogenarian HFpEF subjects.

Methods

We analyzed 87 consecutive subjects aged 80 years or older who were hospitalized for acute decompensated HF with left ventricular ejection fraction (LVEF) ≥50% between 2015 and 2017. Clinical characteristics and a composite event of cardiac death and HF hospitalization were compared in two groups according to SBP cut-off of 140 mmHg on admission.

Results

The prevalence of lower SBP subjects (mean BP = 118 mmHg) and higher SBP (mean BP = 166 mmHg) subjects were 41.4% and 58.6%, respectively. Lower SBP subjects were more comorbid with atrial fibrillation (72.2 vs. 45.1%, p=0.01). In the lower SBP group, diuretics, mineralocorticoid receptor antagonists (MRA), beta-blockers and ACE inhibitors/ARBs were more commonly used than higher SBP group (Table). During the observational period (median = 1.0 year), lower SBP on admission was associated with a 2.65-fold [95% confidence interval (CI): 1.29–5.55, p=0.009] greater likelihood of experiencing the composite events of cardiac death and rehospitalization for HF (Figure). This observation was still consistent even after adjusting clinical demographics and comorbidity [hazard ratio = 2.95, 95% CI: 1.30–6.87, p=0.01].

Table 1 Lower SBP group (n=36) Higher SBP group (n=51) P-value Atrial fibrillation (%) 72.2 0.01 0.01 Loop diuretic (%) 97.1 83.7 0.08 MRA (%) 47.1 24.5 0.04 Beta-blocker (%) 52.9 44.9 0.51 ACE inhibitor/ARB (%) 59.2 29.4 0.01

Figure 1

Conclusions

In octogenarian patients with acute decompensated HF and preserved LVEF, SBP on admission less than 140 mmHg is significantly associated with poor outcomes. Future studies need to prospectively evaluate optimal SBP treatment goals in very elderly patients with HFpEF.
P6264Mitral regurgitation and prognosis after non-ST-segment elevation myocardial infarction in very old patients
Authors: Vera Sainz A , Diez Villanueva P , Ariza Sole A , Formiga F , Lopez Palop R , Marin F , Vidan M , Martinez Selles M , Salamanca J , Sionis A , Garcia Pardo H , Bueno H , Sanchis J , Abu Assi E , Alfonso F
Published: October 2019

Background

Mitral regurgitation (MR) after acute coronary syndromes is associated with adverse prognosis. However, the prognostic impact of MR in older patients with Non ST-segment Elevation Myocardial Infarction (NSTEMI) has not been well addressed.

Methods

The multicenter LONGEVO-SCA prospective registry included 532 unselected patients with NSTEMI aged ≥80 years. Echocardiography performed during admission quantified mitral valve parameters in 497 patients, who were classified according to mitral regurgitation (MR) status in two groups: significant (moderate or severe) or no significant MR (absent or mild). We evaluated the impact of MR status on mortality or readmission at 6-months.

Results

Mean age was 84.3±4.1 years, 308 (61.9%) were males. A total of 108 patients (21.7%) had significant MR. Compared with patients without significant MR these patients had lower systolic blood pressure (132±28 vs 141±27 mmHg), higher heart rate (82±21 vs 74±17 bpm), worse Killip class (≥II 49.5% vs 22.5%), lower ejection fraction (47±14% vs 55±11%), higher pulmonary pressure (42±15 vs 35±11 mmHg), as well as more frequent new onset atrial fibrillation (16.4% vs 7.2%) (all p values=0.001). Patients with significant MR also had higher in-hospital mortality (4.6% vs 1.3%, p=0.04) and longer hospital stay (median 8 [5–12] vs 6 [4–10] days, p=0.002),and higher mortality/readmission at 6 months (HR 1,54, 95% CI 1.09–2.18). However, after adjusting for potential confounders, this last association was not significant.

Conclusions

Significant MR is seen in about one fifth of octogenarians with NSTEMI. Patients with significant MR have a poor prognosis, which is mainly determined by their clinical characteristics.
P6293Assessment of testosterone/estradiol ratio, DHEA-S level and correlation with coronary inflammatory markers IL-1 & 6, TNF-1 and hsCRP predict 5 years risk of cardiovascular disease in men
Authors: Sen N , Tanwar S , Jain A , Sharma J , Gokhroo R K , Mehta A , Kalra B
Published: October 2019

Background

Previous data showed the adrenal sex hormone dehydroepiandrosterone (DHEA) which is present in serum mainly as the sulfate DHEA-S is the most abundant steroid hormone and another hormones like testosterone, estradiol are related to cardiovascular risk in men. Literatures revealed vascular and metabolic actions of DHEA/-S, evidence for an association between DHEA/-S levels and cardiovascular events is controversy.

Objectives

Our aim is to review and clear the contradictory point regarding cardiovascular risk and correlation of testeosterone/ estradiol ratio, DHEA-S level with coronary inflammatory markers in men.

Methods

Large population based cohort study done at multi centre of cardiology from 2013- 2018 in India. We enrolled total 23631 normal healthy male population age between 40 to 60 years and divided into two groups based on testosterone/estradiol ratio (Group A (n=2450) lower value of T/E ratio and Group B (n=21181) normal or higher T/E ratio. We did cohort analysis for 5 years and evaluated DHEA-S level and correlated it with coronary inflammatory markers and cardiovascular risk.

Results

In group A (low T/E ratio) we found low level of DHEA-S (98% of individual) and higher value of interleukins IL-1 (68%),IL-6 (74%) and tumor necrosis factor TNF-1 (71%) and high sensitive C-reactive protein (hsCRP) (73% of individual). Data revealed two fold increase of high blood pressure and LDL cholesterol level as compared to group B (normal or high T/E ratio and normal or high value of DHEA-S). 2.5 fold higher rate of coronary heart disease (CHD) found in group A versus in group B. We did not found as much significant difference in stroke, carotid and peripheral artery disease. T/E ratio and DHEA-S levels were inversely associated with the age-adjusted risk of a CHD event; the hazard ratios and 95% confidence intervals per standard deviation (SD) increase were 0.76 (0.66 to 0.91) and 0.82 (0.72 to 0.93), respectively.

Conclusions

Decrease ratio of testosterone/estradiol levels correlate decreased levels of DHEA-S which may increase the risk of CHD in men. For future aspect, correction of T/E ratio, DHEA-S and increase its awareness should be at mass level for prevention of CHD.
P6295Methotrexate reduces cardiac remodeling and improves left ventricle function in rats with Takotsubo cardiomyopathy
Authors: Guido M C , Lopes N M , Tavares E R , Bispo D L , Tavares De Melo M D , Salemi V M C , Maranhao R C
Published: October 2019

Introduction

Takotsubo cardiomyopathy (TC) is characterized by cardiac disfunction and left ventricle (LV) remodeling caused, mainly, by physical or emotional stress. Previously, we have shown in atherosclerotic rabbits that methotrexate (MTX), an anti-inflammatory chemotherapeutic agent, is capable of reducing the inflammatory process and atherosclerotic lesions.

Purpose

To investigate the effect of MTX treatment in rats with TC.

Methods

TC was induced in Wistar rats with 2 injections of isoproterenol (85mg/kg) with a 24h interval. Animals were allocated in 3 experimental groups: CT: animals induced and treated with saline; TK: animal induced with isoproterenol and treated with saline; TK-MTX: animals induced with isoproterenol and treated with MTX (1mg/kg). Animals were treated every week for 4 weeks. After the treatment, echocardiography, morphometry and molecular analysis (Western blot) of the LV were performed.

Results

TK and TK-MTX groups did not show cardiac dilation or LV intraventricular septum and posterior wall thickening. However, compared to TK, the treatment with MTX improved both LV systolic and diastolic function. In addition, the treatment diminished myocytes diameter and subendocardial and interstitial fibrosis of the LV. Protein expression of pro-apoptotic factors (caspase 3 and BAX), pro-inflammatory cytokine TNF-α, metalloproteinase 2, transforming growth factor beta, collagen I and III and hypoxia-inducible factor 2 alfa were all decreased. Vascular endothelial growth factor (VEGF) and adenosine A1 receptor showed increased protein expression in TK-MTX group when compared to CT and TK. There was correlation of myocardial fibrosis (r2=-0.57), myocytes diameter (r2=-0.78) and VEGF expression (r2=0.58) with LV systolic disfunction. Also, myocardial fibrosis (r2=0.57) and VEGF expression (r2=-0.68) correlated with diastolic disfunction in the LV. Animals treated with MTX did not present any toxicity.

Conclusion

Treatment with MTX diminished apoptosis, the expression of TNF-α and metalloproteinases, cardiac hypertrophy and myocardial fibrosis. Besides that, the treatment increased angiogenesis and strongly improved cardiac function of the LV. MTX, possibly through an increase in the production of intracellular adenosine, could be considered as a feasible treatment for TC.

Acknowledgement/Funding

FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo)
P6329123-Iodine Metaiodobenzylguanitidine imaging: a useful prognostic marker of cardiovascular death in heart failure patients
Authors: Birtolo L I , Scarparo P , Salvi N , Frantellizzi V , Cimino S , Severino P , Maestrini V , Mancone M , De Vincentis G , Fedele F
Published: October 2019

Background

According to guidelines, implantable cardioverter defibrillator (ICD) is recommended in prevention of sudden cardiac death (SCD) in heart failure (HF) patients (pts). Guidelines have several limitations because ICD indication is based mainly on left ventricular ejection fraction (LVEF). Recently, 123-iodine metaiodobenzylguanidine imaging (123-I MIBG) seems to identify, independently from LVEF, pts at high risk of SCD: heart/mediastinum (H/M) ratio<1.6 and summed score (SS)>26.

Purpose

The aim is to assess the role of 123-I MIBG to predict malignant ventricular arrhythmias (VA) in HF pts

Methods

We enrolled 208 pts, admitted to our hospital with diagnosis of HF and LVEF≤35%, NYHA class II and III, who underwent 123-I MIBG imaging. H/M ratio of 1.6 was used as a cut-off to identify high risk (G1) versus low risk pts (G2). All pts underwent ICD implantation. Follow-up was performed at 24 months.

Results

138 patients were included in G1 and 70 patients in G2. All baseline characteristics were similar in the two groups (table 1). At 24 months follow-up VA events were recorded greater in G1 compared to G2 (21% vs 10%, p=0.04).

Table 1 G1 G2 P value H/M ≤1.6 (N=138) H/M >1.6 (N=70) Age (years) 65±12 63±14 0.28 Male, N (%) 108 (78) 64 (91) 0.02 Diabetes mellitus type II, N (%) 54 (39) 14 (20) 0.01 Dyslipidemia, N (%) 58 (42) 30 (42) 0.64 LVEF (%) 30±5 31±4 0.14 Ischaemic CM, N (%) 85 (62) 30 (42) 0.012 Malignant VA, N (%) 30 (21) 7 (10) 0.04 SS 38±9 16±7 0.0001 H/M: heart mediastinum ratio; LVEF: left ventricular ejection fraction; CM: cardiomyopathy; VA: ventricular arrhythmias; SS: summed score.

Conclusion

Our results seem to confirm that 123-I MIBG uptake is associated with the occurrence of life-threatening VA in HF pts independently from LVEF. The use of 123-I MIBG could be a useful tool in the future to increase the specificity of the pts selection for ICD therapy.
P6349Inflammation mitigation improves post-infarction functional recovery of the heart
Authors: Ivanov M , Tacu L , Todiras M , Moraru I , Cobet V , Popovici M
Published: October 2019

Aim

The in vitro evaluation of the cardiac functional effects of TNF-α antagonist administration in rats after isoproterenol induced myocardial infarction.

Material and methods

Myocardial infarction was reproduced using a proven model based on isoproterenol i/p administration in rats in 2 consecutive days in a similar dose, 150 mg/kg. In another group the animals after isoproterenol induced myocardial infarction (series IMI) have received daily TNF-α antagonist, a specific monoclonal antibody (ma-TNF-α) i/p in dose of 50 mg/kg during 8 days (series IMI+ma-TNF-α). In both series the animals were sacrificed after 10 days from the 1st injection and their isolated hearts ware perfused with Krebs solution according to Langendorff and Neely-Rovetto models.

Results

The most remarkable traits of left ventricle dysfunction in IMI in comparison to control were following: (1) diminution of cardiac output (CO), systolic pressure (SP) and +dP/dT max by respectively 28,7 and 34,7 and 23,3%; (2) negative inotropic effect to action of endothelin-1 manifested by decrease of SP and aortic jet during stimulation up to 13,9%; (3) increased cardiac arrhythmogenic activity in response to calcium overload; (4) increasing by 45,2% of ischemia induced contracture as well as decreasing by 37,5% of SP during reperfusion. The ma-TNF-α administration in post-infarction period led to noticeable benefits such as: significant enhancement of SP and CO respectively by 17,3 and 18,6% as well as positive inotropic effect developing to ET-1 action as well as significant increase of time regarding the appearance of ventricular extrasystole and ventricular tachyarrhythmia by respectively 12,9 and 11,7% as well as perceptible improvement of ischemia-reperfusion syndrome.

Conclusion

A sustained inflammation inhibition by ma-TNF-α administration in post-infarction period improves tangibly the cardiac functioning that proves the role of inflammatory response in myocardial infarction induced functional and structural myocardial remodeling and underlines the inflammation as a therapeutic target.
P6356Comparisons of clinical outcomes in patients with heart failure with preserved ejection fraction with and without atrial fibrillation: results from a multicenter PURSUIT-HFpEF registry
Authors: Masuda M , Kanda T , Asai M , Mano T , Yamada T , Yasumura Y , Uematsu M , Hikoso S , Nakatani D , Tamaki S , Higuchi Y , Nakagawa Y , Fuji H , Abe H , Sakata Y
Published: October 2019

Background

The presence of atrial fibrillation (AF) has been demonstrated to be associated with poor clinical outcomes in heart failure patients with reduced ejection fraction.

Objective

This study aimed to elucidate the impact of the presence of atrial fibrillation (AF) on the clinical characteristics, therapeutics, and outcomes in patients with heart failure and preserved ejection fraction (HFpEF).

Methods

PURSUIT-HFpEF is a multicenter prospective observational study including patients hospitalized for acute heart failure with left ventricular ejection fraction of >50%. Patients with acute coronary syndrome or severe valvular disease were excluded.

Results

Of 486 HFpEF patients (age, 80.8±9.0 years old; male, 47%) from 24 cardiovascular centers, 199 (41%) had AF on admission. Patients with AF had lower systolic blood pressures (142±27 vs. 155±35mmHg, p<0.0001) and higher heart rates (91±29 vs. 82±26bpm, p<0.0001) than those without. There was no difference in the usage of inotropes or mechanical ventilation between the 2 groups. A higher quality of life score (EQ5D, 0.72±0.27 vs. 0.63±0.30, p=0.002) was observed at discharge in patients with than without AF. In addition, AF patients tended to demonstrate lower in-hospital mortality rates (0.5% vs. 2.4%, p=0.09) and shorter hospital stays (20.3±12.1 vs. 22.6±18.4 days, p=0.09) than those without. During a mean follow up of 360±111 days, mortality (14.1% vs. 15.3) and heart failure re-hospitalization rates (13.1% vs. 13.9%) were comparable between the 2 groups.

Conclusion

In contrast to heart failure patients with reduced ejection fraction, AF on admission was not associated with poor long-term clinical outcomes among HFpEF patients. Several in-hospital outcomes were better in patients with AF than in those without.

Acknowledgement/Funding

None
P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?
Authors: Vidal-Perez R , Agra-Bermejo R , Pascual-Figal D , Gude Sampedro F , Abou Jokh C , Delgado Jimenez J , Varela-Roman A , Gomez Otero I , Ferrero-Gregori A , Alvarez-Garcia J , Worner Diz F , Segovia J , Cinca J , Fernandez-Aviles F , Gonzalez-Juanatey J R
Published: October 2019

Background

The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients.

Purpose

The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes.

Methods

We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission.

Results

The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1)

Effect of post-discharge heart rate

Conclusions

In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients

Acknowledgement/Funding

Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de
P6363Achieved blood pressure and cardiovascular outcomes in hypertensives
Authors: Park H.-Y , Lim N.-K , Kim W.-H , Lee J.-W , Cho M.-C
Published: October 2019

Background/Introduction

Lowering blood pressure is very beneficial in reducing the risk of cardiovascular morbidity and mortality. But, the extent of optimal target blood pressure in hypertensive patients is still controversial.

Purpose

The objectives of this study were to assess the level of proper systolic and diastolic blood pressure to prevent cardiovascular events in older and younger patients.

Methods

We used the National Sample Cohort from the National Health Insurance Service of 2007 to 2013 in Korea and analyzed data from 44,462 hypertensive patients aged from 20 to 84, treated with one or more antihypertensive agents and participated at least one general health examination. Achieved systolic and diastolic blood pressure (SBP/DBP) were categorized by exclusive average achieved SBP (<120, <130, <140, <150, and ≥150 mmHg) and DBP (<70, <80, <90, <100, and ≥100 mmHg) categories using the blood pressure measurements of one or more available health examinations. The primary outcome was defined as composite, which was the first occurred event among admissions of myocardial infarction, stroke, and heart failure or cardiovascular death. Secondary outcomes were individual components of composite outcome and all-cause death.

Results

Of 44,462 patients, 5,478 (12.3%), 13,410 (30.2%), 15,021 (33.8%), 7,051 (15.9%), and 3,502 (7.9%) patients achieved SBP <120 mm Hg, 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and ≥150 mm Hg, respectively. During the median follow-up of 6.8 years, 2,151 (4.8%) died by all-cause of death, and 2,463 (5.5%) met the criteria of composite outcome. In elderly patients, compared with achieved SBP 120–129 (reference), there was no significant increase in risk at SBP 130–139 mm Hg and 140–149 mm Hg, but SBP 150 mm Hg or more was positively associated with significant risk of composite outcome and all-cause death, with HR of 1.29 (95% CI, 1.11–1.51) and 1.66 (95% CI, 1.43–1.92), respectively (Figure). On the other hand, in younger patients, the risk for incidence of composite outcome was significantly increased both at SBP 140–149 mm Hg (HR, 1.39; 95% CI, 1.11–1.73) and 150 mm Hg or more (HR, 2.00; 95% CI, 1.53–2.62) In addition, an achieved SBP 130 mm Hg and more was also significantly associated with all-cause death with HR of 1.27 (95% CI, 1.00–1.62). Compared with 120–129 mm Hg, elderly patients who had achieved SBP less than 120 mm Hg were more likely to have increased risk for composite outcome (HR, 1.29; 95% CI, 1.10–1.52), but not in younger patients (HR, 1.01; 95% CI, 0.78–1.30).

Conclusion

In conclusion, an intensive lowering of blood pressure is more likely to increase the risk rather than to prevent major cardiovascular events and all-cause death, particularly in older than younger. Therefore, an intensive blood pressure lowering of SBP/DBP below 120/70 mm Hg in the elderly should be avoided.

Acknowledgement/Funding

The Korea National Institute of Health research grant 2017-NI63001-00
P6367Predictors and covariables of incident hypertension in midlife: the Hordaland Health Study
Authors: Kringeland E A , Tell G S , Midtbo H B , Haugsgjerd T , Gerdts E
Published: October 2019

Background

Different blood pressure (BP) development in midlife have been described in women and men. Less is known about factors associated with incident hypertension in this age group.

Purpose

To identify predictors and covariables of incident hypertension in women and men in their forties.

Methods

2936 women (60%) and men born 1950–51 who participated in the community-based Hordaland Health Study both in 1992–93 (baseline, mean age 42±0.7 years) and in 1997–99 and were normotensive at baseline were included. Hypertension was defined as use of antihypertensive medication and/or systolic BP ≥140 mmHg and/or diastolic BP ≥90 mmHg. High-normal BP was defined as systolic BP 130–139 mmHg and/or diastolic BP 85–89 mmHg following European guidelines. Predictors and covariables of incident hypertension were identified in logistic regression analyses and reported as odds ratio (OR) and 95% confidence intervals (CI).

Results

348 (12%) subjects developed hypertension during an average of 5.9 years follow-up. Incident hypertension was more common among men than women (14% vs. 10%, p=0.005). In univariate analyses, incident hypertension was positively associated with high normal BP and higher body mass index (BMI), serum total cholesterol and serum triglycerides at baseline, as well as with larger increase in BMI and serum triglycerides during follow-up (all p<0.05). In multivariable analysis, incident hypertension was associated with high-normal BP and higher serum triglycerides at baseline, and larger increase in BMI during follow-up, while the association with sex became non-significant (Table).

Variable Multivariable analysis OR (95% CI) P-value High-normal BP 4.87 (3.82–6.20) <0.001 ΔBMI at follow up (kg/m2) 1.33 (1.24–1.42) <0.001 Ln serum triglycerides (mmol/L) 1.41 (1.14–1.75) 0.002

Conclusion

In the community-based Hordaland Health Study, a larger proportion of men than women developed hypertension in midlife. However, this sex difference in incidence was explained by differences in prevalence of high-normal BP at baseline and metabolic factors.
P6388Effects of Interleukin-1 blockade with anakinra in patients with ST-segment elevation acute myocardial infarction on recurrent ischemic events: results from the VCUART3 study
Authors: Van Tassell B , Lipinski M J , Appleton D , Trankle C R , Kadariya D , Abouzaki N A , Canada J M , Carbone S , Buckley L F , Melchior R , Thomas C , Garnett J , Puckett L , Kontos M C , Abbate A
Published: October 2019

Background

ST-segment elevation myocardial infarction (STEMI) is associated with an intense acute inflammatory response and an increased risk of recurrent ischemic events. Prior studies of IL-1 blockade have shown conflicting results regarding the risk of future events.

Methods

We enrolled patients with STEMI within 12 hours of presentation at 3 sites in the United States of America. After revascularization, patients were randomly assigned to receive anakinra 100 mg twice daily, anakinra 100 mg once daily (standard dose) alternated with placebo once daily every 12 hours, or placebo every 12 hours for 14 days in 1:1:1 ratio. Prespecified exploratory endpoints for recurrent ischemic events, adjudicated by an independent committee, evaluated the composite risk of subsequent acute myocardial infarction (AMI, World Health Organization classification Type 1), unstable angina, or urgent revascularization. Data are expressed as median and interquartile range or number and percentage. Cox regression analysis was used to generate unadjusted hazard ratios and confidence intervals. (ClinicalTrials.gov number, NCT01950299)

Results

Of 311 patients screened, 99 subjects (81% males, 58% Caucasians, 55 [49–62] years of age) were randomly assigned to anakinra twice daily (N=31), anakinra once daily (N=33) or placebo (N=35). The cohort included patients with hypertension (57%), tobacco use (55%), diabetes mellitus (30%), and prior diagnosis of coronary artery disease (21%) without statistically significant imbalances in the demographic characteristics between groups (all P>0.05). Discharge medications for the index STEMI admission, in addition to the study medication, included aspirin (100%), statins (100%), P2Y12 inhibitors (100%), beta-blockers (90%), and angiotensin converting enzyme inhibitor/angiotensin receptor blocker (84%), without statistically significant imbalances between the 3 groups. Over the 1-year follow-up, recurrent ischemic events occurred in 5/35 (14.3%) patients treated with placebo and 6/64 (9.1%) patients treated with anakinra (hazard ratio = 0.68 [0.20–2.24], P=0.53). No differences were observed between high- and low-dose anakinra treatment groups.

Conclusions

A two week treatment with IL-1 receptor antagonist, anakinra, did not significantly decrease or increase recurrent ischemic events over the course of a 1-year follow-up in patients with STEMI.

Acknowledgement/Funding

Funded by NHLBI 1R34HL121402; Drug supply by Swedish Orphan Biovitrum
P6397Ejection fraction by cardiac magnetic resonance 6 months after STEMI: impact on risk stratification in chronic phase
Authors: Merenciano Gonzalez H M , Marcos-Garces V , Gavara J , Rios-Navarro C , Ortiz J T , Rodriguez J , Mendieta G , Rodriguez-Palomares J F , Valente F , Garcia-Dorado D , Lopez-Lereu M P , Monmeneu J V , Nunez E , Nunez J , Bodi V
Published: October 2019

Background

Left ventricular ejection fraction (LVEF) has traditionally been used as the cornerstone for risk stratification after STEMI and it can be accurately quantified by cine cardiovascular magnetic resonance (CMR). In recent years, the additional prognostic value of contrast CMR-derived infarct size (IS) and microvascular obstruction (MVO) soon after infarction has been demonstrated. The usefulness of CMR-derived LVEF in chronic phase for risk stratification late after STEMI is unclear.

Purpose

We hypothesized that 6-month CMR-derived LVEF can contribute in the prediction of clinical events late after STEMI beyond pre-discharge LVEF, IS and MVO.

Methods

Data were obtained from a prospective registry of reperfused STEMI patients (n=456) who were stable 6 months after infarction and in whom 1-week and 6-month CMR-derived LVEF, IS and MVO were sequentially quantified. Major adverse cardiac events (MACE) were defined as a combined clinical end-point that included death or re-admission for acute decompensated heart failure (r-ADHF), whichever occurred first, occurring after the 6-month CMR.

Results

During a mean and median follow-up of 6 years, 56 late MACE (12%, 32 deaths and 24 r-ADHF) were registered. From 1-week to 6-month, CMR parameters exhibited significant dynamic changes (p<0.001): LVEF improved (52±12 vs. 56±13%), IS decreased (21±14 vs. 18±12% of LV mass) and MVO vanished (2±4 vs. 0±1% of LV mass). At 6-month CMR, 60 patients (13%) displayed reduced LVEF (<40%), 69 (15%) mid-range LVEF (40–50%) and 327 (72%) preserved LVEF (≥50%). Late MACE rates were 28% in patients with reduced LVEF, 14% in those with mid-range LVEF and 9% in those with preserved LVEF at 6-month CMR (p<0.001 for the trend). After adjustment for baseline characteristics and for 1-week and 6-month CMR parameters, more preserved LVEF at 6 months independently associated with a lower risk of MACE late after STEMI (hazard ratio 0.96 [0.94–0.98] per 1% increase).

Conclusions

Dramatic dynamic changes occur in CMR parameters within the first months after STEMI. Reassessment of CMR-derived LVEF in chronic phase in those patients who remain stable provides relevant prognostic information for long-term risk stratification.

Acknowledgement/Funding

Funded by “Instituto de Salud Carlos III”/FEDER (PIE15/00013, PI17/01836, and CIBERCV16/11/00486 grants) and Generalitat Valenciana (GV/2018/116).
P6399Left atrial function determined by echocardiography predicts incident heart failure in STEMI patients treated with primary percutaneous coronary intervention
Authors: Modin D , Pedersen S , Fritz-Hansen T , Gislason G , Biering-Soerensen T
Published: October 2019

Objectives

To assess the comparative effectiveness of LA functional parameters (LAEF and MinLAVI) with that of LA volume index (LAVI) in predicting HF following STEMI.

Background

Heart failure (HF) is common following STEMI. Enlarged left atrial (LA) volume determined by echocardiography is associated with adverse outcome following STEMI. However, whether echocardiographic parameters of LA function, such as the LA emptying fraction (LAEF) and the minimal LA volume index (MinLAVI), are superior to LAVI for predicting prognosis following STEMI is unknown.

Methods

A total of 369 STEMI patients without atrial fibrillation or heart failure treated with primary percutaneous coronary intervention (pPCI) were prospectively enrolled in the period September 2006 to December 2008. Patients underwent echocardiography shortly after STEMI. The maximal and minimal LA volume were measured using the biplane area-length method. LAVI, MinLAVI (minimal LA volume indexed to body surface area) and LAEF [(maximal LA volume − minimal LA volume) / maximal LA volume] were calculated. End-point was incident HF.

Results

During a median follow-up of 66 months (interquartile-range: 50–73 months), 68 patients (18%) were admitted for HF. In univariable analysis, both reduced LAEF and increased MinLAVI were significantly associated with an increased risk of HF (LAEF: HR 1.18, 95% CI 1.08–1.29, per 5% decrease, p<0.001) (MinLAVI: HR 1.35, 95% CI 1.09–1.67, per 5 mL/m2 increase, p=0.006) (Figure). In contrast, LAVI was not significantly associated with the development of HF (HR 1.03, 95% CI 0.87–1.22, per 5 mL/m2 increase, p=0.73) (Figure). Following adjustment for clinical, biochemical and echocardiographic variables, LAEF and MinLAVI remained independent predictors of HF, while the lack of association between LAVI and HF persisted (LAEF: HR 1.14, 95% CI 1.02–1.27, per 5% decrease, p=0.019) (MinLAVI: HR 1.31, 95% CI 1.02–1.69, per 5 mL/m2 increase, p=0.036) (LAVI: HR 1.05, 95% CI 0.86–1.29, per 5 mL/m2 increase, p=0.61). These results were replicated when treating death from all causes as a competing event in competing risk regression.

PY, person-years

Conclusion

In STEMI patients treated with pPCI, LAEF and MinLAVI measured by echocardiography shortly after infarction are superior to LAVI for predicting incident HF.
P6400Risk for heart failure after acute myocardial infarction, a nationwide report on 73 303 patients with and without diabetes 2012–2017 in the SWEDEHEART-SCAAR registry
Authors: Ritsinger V , Lagerqvist B , Saleh N , Nystrom T , Norhammar A
Published: October 2019

Background

Impressive improved one-year survival rates after acute myocardial infarction (AMI) have been achieved the last decades while long-term cardiovascular events still are a challenge particularly when diabetes is present. Recently several glucose lowering drugs with preventive effects on heart failure (HF) and MACE have entered the market however still used in low proportion by cardiologists.

Purpose

To explore the real-life complication rates of HF after AMI in patients with and without diabetes.

Methods

All patients with AMI admitted for coronary angiography in Sweden 2012–2017 were followed for time to first hospitalisation with HF diagnosis (ICD-10 code I50) until December 2017. Kaplan-Meier curves were used to estimate the cumulative heart failure event stratified by previous MI. Hazard ratios (HR) were calculated in a Cox proportional hazard regression model adjusting for age, gender, smoking, creatinine, previous CABG/cancer/dementia/dialysis/hypertension/COPD/renal failure/stroke, year, indication, hospital, angiographic findings, primary decision after angiography, cardiac chock, medications at discharge.

Results

Of 73 303 patients, mean age was 69 years (SD±12), 69% were men and 24% had diabetes. In all, HF occurred in 14% with a higher rate in patients with diabetes than those without (22% vs 12%). The highest HF rates were seen in patients with previous MI (33% if diabetes was present vs. 23% if no diabetes). After adjustments, patients with diabetes without previous MI had about the same HF risk (HR 1.52 [95% CI 1.44–1.61]) as patients without diabetes with previous MI (1.48 [1.40–1.57]) where patients without diabetes and previous MI served as a reference. The same pattern was seen regardless of STEMI/NSTEMI and also after excluding patients with previous HF (n=4567, 6%; Figure; patients with diabetes without previous MI 1.48 [1.40–1.57] and patients without diabetes with previous MI 1.27 [1.19–1.36]).

Conclusion

Heart failure is a common complication after AMI in patients with diabetes, particularly if previous MI, and regardless of previous reported heart failure. Diabetes increases the risk of heart failure by 30–50% compared to those without diabetes. These data indicate the existence of a large diabetes population at heart failure risk after AMI where heart failure protective glucose lowering drugs could be suitable.

Acknowledgement/Funding

The Swedish Heart and Lung foundation, Department of Research and Development Region Kronoberg, the Kamprad Family Foundation
P6406Platelet reactivity in Hepatitis C virus infected patients on dual antiplatelet therapy for acute coronary syndrome
Authors: Scudiero F , Valenti R , Marcucci R , Sanna G D , Gori A M , Migliorini A , Vitale R , Giusti B , De Vito E , Corda G , Paniccia R , Parodi G
Published: October 2019

Background

Coronary artery disease (CAD) has been recognized as a serious and potentially life-threatening complication of Hepatitis C Virus (HCV) infection. High on treatment platelet reactivity has been associated with high risk of ischemic events in patients with CAD, but data regarding the association with HCV infection are still lacking.

Purpose

We sought to assess platelet reactivity on dual anti-platelet therapy and long-term outcome of acute coronary syndrome (ACS) patients infected with HCV.

Methods

ACS patients infected with HCV were matched to ACS patients without HCV for age, sex, diabetes, hypertension and renal function. Primary and secondary study endpoints were the proportion of patients with high on treatment platelet reactivity (HTPR) and long-term outcomes, respectively.

Results

HCV-infected ACS patients had higher levels of platelet reactivity (ADP10-LTA: 56% ± 18% vs. 44% ± 22%; p=0.002; Arachidonic Acid-LTA: 25% ± 21% vs. 16% ± 15%; p=0.011) and higher rate of HTPR on clopidogrel and aspirin compared with non-HCV patients. Multivariable analysis demonstrated HCV-infection to be an independent predictor of HTPR. At follow-up, estimated major adverse clinical events (MACE: cardiac death, non fatal myocardial infarction and any revascularization) were 57% vs. 37%, p=0.006 in HCV-infected ACS and non-HCV, respectively. Also, TIMI major bleeding rates were higher in HCV-infected subjects (11% vs. 3%; p=0.043) as compared with non-infected patients.

Platelet function according to HCV status

Conclusions

ACS patients with HCV infection have increased on treatment platelet reactivity, higher rate of HTPR, MACE and bleedings as compared with non-HCV patients.
P6413Aging increases the plaque vulnerability in non-ischemic non-culprit lesions of diabetic patients, data from COMBINE OCT-FFR study
Authors: Kedhi E , Berta B , Ijsselmuiden A , Alfonso F , Kauer F , Hermanides R , Wojakowski W , Roleder T
Published: October 2019

Background

Little is known about age-related differences in baseline atherosclerotic plaque morphology and composition in patients with diabetes mellites (DM).

Purpose

For this purpose, we studied DM patients from the Combine trial.

Methods

COMBINE (OCT-FFR, NCT02989740) is a multi-center, prospective study focusing on the natural history of non-ischemic, non-culprit coronary lesions and evaluate whether certain OCT-assessed variables could predict future adverse events originating from these lesions in a DM population. OCT analysis identifies plaque composition, estimates calcium arc (o), lipid arc (o), and measures thickness of the fibrous cap covering the lipid core. Moreover, OCT records the presence of typical plaque vulnerability traits like thin fibrous cap atheroma (TCFA), plaque erosion (PE), plaque rupture (PR), calcification nodule (CN), heterogeneous tissues (a probably healed plaque rupture), and macrophages accumulation (bright spots). A dedicated software estimated the interpolated percentage area stenosis (AS, %) measuring the minimal lumen area (MLA) and reference vessel area. The present analysis reports the baseline morphology of these lesions respectively in young (<70 years) vs. old (≥70 years) DM patients.

Results

OCT imaging was performed in 300 patients (361 lesions) from the COMBINE study, of which 203 lesions assessed in young and 158 lesions in old DM patients. There were no significant differences in MLA (mm2) 2.40 (1.85–315 vs. 2.30 (1.80–3.00), p=0.92), lesions length (mm 24.11 (15.10–33.10) vs. 24.20 (15.10–35.10), p=0.78), AS% (%) 63 (1.85–3.15) vs. 64 (56–73), p=0.41; lipid arc (o), 182 (140–250) vs. 175 (128–240), p=0.35), fibrous cap thickness covering the lipid arc (μm), 117 (65–193) vs. 110 (64–168), p=0.45, in the prevalence of TCFA 37 (18%) vs. 33 (21%), p=0.53, PR 17 (18%) vs. 15 (10%), p=0.71, heterogenous tissue 39 (19%) vs. 31 (20%), p=0.92, and bright spots 98 (48%) vs. 69 (44%), p=0.38. The patients ≥70 years had a higher prevalence of calcified plaques 171 (84%) vs. 143 (90%), p=0.08 and wider calcium arc. These lesions included more PE 7 (3%) vs. 13 (8%), p=0.05, CN 73 (36%) vs. 75 (47%), p=0.03, and CN associated with overlying thrombus 11 (5%) vs. 20 (13%), p=0.02.

Conclusion

Non-ischemic, non-culprit lesions in elderly DM patients present the same prevalence of soft, vulnerable plaques as it is a younger cohort, however, they have a higher prevalence of calcified plaque including complex calcified plaques as eroded plaques and calcification nodules with overlying thrombus. Whether these complex calcified plaques are associated with a higher risk of adverse events remains questionable and could be further elucidated from longer follow-up data of the COMBINE trial.
P6416Lower serum syndecan-1 level is associated with higher prevalence of vulnerable plaque in patients with coronary artery disease
Authors: Nemoto T , Minami Y , Yamaoka-Tojo M , Sato T , Muramatsu Y , Kakizaki R , Hashimoto T , Fujiyoshi K , Meguro K , Shimohama T , Ako J
Published: October 2019

Introduction

Syndecan-1 is a component of endothelial glycocalyx which maintains vascular integrity. Thus, it may be impaied in patients with coronary artery disease (CAD).

Purpose

To assess the association between serum syndecan-1 level and the severity and vulnerability of CAD.

Methods

A total of 259 consecutive patients with stable angina requiring percutaneous coronary intervention (PCI) were prospectively enrolled. Patients were classified into 2 groups according to the median syndecan-1 value (Lower syndecan-1 group [syndecan-1 <99.0], n=130; Higher syndecan-1 group [syndecan-1 ≥99.0], n=129). Severity of CAD and focal plaque vulnerability in target lesion was evaluated using findings of angiography and optical coherence tomography (OCT), respectively. Thin-cap fibroatheroma (TCFA) was defined as a lipid-rich plaque covered with thin fibrous cap (<65 μm).

Results

There was no significant difference in baseline clinical characteristics between the lower syndecan-1 group and the higher syndecan-1 group other than the prevalence of family history of ischemic heart disease (19 vs. 32%, p=0.022) and prior PCI history (45 vs. 60%, p=0.015). The prevalence of multivessel disease (70 vs. 68%, p=0.627), left main disease (4 vs. 5%, p=0.748) and chronic total occlusion (15 vs. 15%, p=0.959) was comparable between the 2 groups. On the other hand, the prevalence of lipid-rich plaque (40 vs. 19%, p=0.004) and TCFA (20 vs. 6%, p=0.006) was significantly higher in the lower syndecan-1 groupthan the higher syndecan-1 group (Figure). The lower syndecan-1 was independently associated with the higher prevalence of lipid-rich plaque (Table).

Table 1. Multivariate analysis for lipid-rich plaque Odds ratio 95% CI pvalue Lower syndecan-1 2.981 1.448–6.411 0.003 Dyslipidemia 1.693 0.738–4.142 0.218 Chronic kidney disease 1.354 0.669–2.765 0.400 Smoking 0.975 0.453–2.154 0.951 Diabetes mellitus 0.819 0.400–1.661 0.580

Conclusions

Lower syndecan-1 level was associated with higher prevalence of vulnerable plaque in patients with CAD. Serum syndecan-1 may have a potential as a marker for the presence of vulnerable coronary plaque.
P6420Can machine learning help us improve risk stratification of diabetic patients with acute coronary syndromes? The answer will blow your mind
Authors: Milner J , Monteiro S , Monteiro P , He M , Simpson C , Zaslavskiy M , Balazard F , Li L , Rousset A , Schopf S , Dellamonica D , Goncalves L
Published: October 2019

Background

Risk stratification following an acute coronary syndrome (ACS) is of utmost importance, in order to identify patients at higher risk of subsequent cardiovascular events. Diabetic patients have a significantly worse prognosis, so new risk prediction tools are important to better identify and risk stratify high risk patients within this important ACS subpopulation.

Aim

The aim of this study was to identify the best predictors of a new ACS, in a single-center database of ACS, resorting to machine learning and artificial intelligence, and to compare the Global Registry of Acute Coronary Events (GRACE) risk score's relevance for risk discrimination in a general ACS population versus a subpopulation of diabetic patients.

Methods

In a single center, 5977 patients admitted due to ACS between 2004 and 2017 and alive at discharge were studied. In the subpopulation of diabetic patients (n=3429), each covariate present in the database was analyzed separately with a Cox proportional hazard model with three terms – subpopulation belonging indicator, covariate, interaction term. The p-value of the interaction term was used to rank variables. The more significant the interaction term, the stronger the change in relationship between patients in the subpopulation and the risk of a new ACS, compared to the one in the general population.

Results

During long term follow-up, 13% of patients (n=771) experienced a second event. Kaplan-Meier curve represents how ACS free-survival depends on the GRACE risk score and group of interest. In the general population and in the subpopulation of diabetic patients, the GRACE score was used to further divide patients into 3 terciles, of which only the lower and upper tercile are shown (GRACE ≤113 and GRACE >144, respectively). The solid lines represent Kaplan-Meier curves for diabetic patients, and the dotted lines in the general population. Pink or grey colour of the curves represent the stratification level of the covariate.

Conclusions

In our model, the GRACE risk score was found to be a better discriminator of risk of futher ACS in diabetic patients than in the general ACS population. Strikingly, a higher GRACE score predicts a lower rate of readmission, probably because many patients will die in the index hospitalization or out of hospital. This finding reinforces the usefulness of the GRACE score in high risk patients and may improve risk stratisfication in diabetic post-ACS patients, making sure that they are closely followed and submitted to optimal risk factor management, in order to improve their post-ACS prognosis.
P6428The waist-to-body mass index ratio is a better predictor for cardiovascular outcome in patients with established atherosclerotic cardiovascular disease - No u-shaped phenomenon
Authors: Hsuan C F , Lin F J , Tseng W K , Wu Y W , Yin W H , Yeh H I , Chen J W , Wu C C
Published: October 2019

Background

Many studies have observed an “obesity paradox” in patients with established atherosclerotic cardiovascular disease (ASCVD), in which the body mass index (BMI)-mortality curve is U-shaped.

Purpose

To search a better anthropometric parameter to predict the cardiovascular events in patients with ASCVD.

Methods

The study was conducted from the Taiwanese Secondary Prevention for patients with AtheRosCLErotic disease (T-SPARCLE) Registry. Adult patients with stable ASCVD were enrolled. The primary composite endpoint of this study is the time of the first major cardiovascular event, defined as cardiovascular death, nonfatal myocardial infarction or stroke, or cardiac arrest with resuscitation. Dose response association between primary outcome events and various traditional anthropometric parameters and a new parameter, the waist-to-BMI ratio, was examined using the Cox proportional hazards regression model. We used restricted cubic spline regression to investigate the potential nonlinear relationship between each anthropometric measure and primary outcome events.

Results

A total of 6921 patients with ASCVD were included in this analysis, and were followed up for a median of 2.5 years. Multivariable Cox proportional hazards regression showed a significant positive association between the waist-to-BMI ratio and the primary outcome events (adjusted hazard ratio 1.67, 95% CI 1.12–2.49, p=0.01). Other traditional anthropometric parameters, such as BMI, weight, waist and waist-hip ratio, did not showed significant associations (p=0.10, 0.31, 0.90, and 0.52, respectively). In the restricted cubic spline regression, the positive dose response association between the primary outcome and the waist-to-BMI ratio persisted across all the waist-to-BMI ratio, and was non-linear (the likelihood ratio test for nonlinearity was statistically significant, p<0.001) with a much steeper increase in the major cardiovascular event for the waist-to-BMI ratio >3.6 cm m2/kg.

Dose response curve of waist/BMI ratio

Conclusion

This study found the waist-to-BMI ratio to be a better predictor for major adverse cardiovascular events in established ASCVD patients than other traditional anthropometric parameters.