bluuebunny/crossref_metadata_2025 huggingface dataset:
P2516Cardiac rehabilitation program - experience and outcomes in a tertiary center
Authors: Castelo A , Rio P , Alves S , Silva A S , Mano T , Ferreira V , Bras P , Ferreira R
Published: October 2019

Introduction

Cardiac rehabilitation (CR) programs are effective in improving functional capacity and reducing mortality. The level of adherence to them seems to be less than the ideal, and some factors can predict non-compliance with impact on outcomes.

Purpose

The aim was to characterize the population of the cardiac rehabilitation (CR) appointment, determine factors predictive of compliance with the standard CR exercise program and evaluate the benefits of the program.

Methods

Retrospective analysis of patients in a CR appointment at a single center between 2014 and 2017. Patients (P) were divided into two groups: compliance >80% of the program (GI) and non-compliance (GII). We assessed clinical, laboratory, and echocardiographic characteristics and determined predictors for compliance and compared the follow-up to date.

Results

270P (83% men) were included, with a mean age of 57 years. The P had a median follow up of 35 months, with an interquartil interval of 28 months. The majority (92.5%) had at least one cardiovascular risk factor (25.1% diabetes, 57.1% hypertension, 72.8% dyslipidemia, 75.8% obesity or weight excess, with mean body mass index (BMI) 27.3±3.46, 16.7% family history, 19.8% acute myocardial infarction (AMI), 48.2% smoking). 99% of the patients were medicated (93.7% acetylsalicylic acid, 67.3% clopidogrel, 24.1% ticagrelor, 95.6% beta-blocker, 93.7% ACEI/ARB, 95.5% statin). 144P (53.3%) were not from Lisbon. Most patients (77%) were referred after AMI, 8.9% with heart failure (HF), 8.5% with stable or unstable coronary disease and 1.9% with valvulopathy. 69P (25.6%) attended >80% of the CR program. Death occurred in 4.4% of the P (71.4% cardiovascular causes) and 27% had at least 1 hospitalization. Age, sex, economic insufficiency and residence local (Lisbon or non-Lisbo) were not predictors of non-compliance (p=0.859, p=0.656, p=0.914 and p=0.515 respectively). Predictors of non-compliance were higher IMC (CC=-0.141, p=0.014), higher cholesterol (CC=-0.140, p=0.016), higher C reactive protein (CC=-0.120, p=0.043), higher HbA1c (CC=-0.170, p=0.008) and CR for heart failure (HF) (OR = 0.715, IC [0.659–0.775], p=0.002). Of these, higher HbA1C (p=0.018) and CR for HF (p=0.034) were independent predictors. Compliance with>80% of the program was associated with lower overall mortality (OR = 0.732, IC [0.679–0.788], p=0.037), but not as an independent factor (p=0.378). The only independent predictor of mortality were BNP (p<0.0001).

Conclusion

Of the patients referred to the CR consultation one fourth concludes the program. Several factors can predict non-compliance, with higher HbA1c and CR for HF being independent predictors. Compliance with the CR program is associated with lower overall mortality.
P2520Predictors of success of biofeedback in the rehabilitation of patients after acute myocardial infarction
Authors: Leonova I , Boldueva S , Yarmosh I , Suvorov N
Published: October 2019

In current work, it were evaluated clinical predictors for the success of biofeedback (BF) sessions during cardiorespiratory training (CT) by cardiac rhythm for the development of cardiorespiratory synchronization (CRS) in addition to standard therapy in patients with myocardial infarction (MI) in early periods.

The study included 50 patients with uncomplicated MI on 6–10 days of disease. 21 patients developed stable CRS during training in the hospital. All patients underwent general clinical examination: control of blood pressure, heart rate, ECG, echocardiography, assessment of heart rate variability (HRV).

Using of discriminant analysis of initial clinical parameters, heart rate variability parameters and cardiorespiratory training, a mathematical model was constructed that allows predict the success of CT in patients in early period of MI with a probability of 96.7%.

f = −8.85 + 0.21X1 + 3.87X2 − 4.96X3 − 1.72X4 + 3.5X5 − 1.57X6 − 1.58X7 − 0.69X8 + 1.63X9 + 0.008X10 − 0.069X11 + 0.089X12 + 2.71X13 − 2.61X14 + 5.65X15 where X1 is the left ventricular ejection by echocardiography, X2 is the number of MI, X3 is the presence of previous history of coronary artery disease, X4 is diabetes, X5 is smoking, X6 is thrombolysis, X7 is coronary artery stenting, X8 is SDNN by HRV, X9 – CV by HRV, X10 – TP by HRV, X11 – HR in the first active test, X12 – diastolic blood pressure in the first inactive test, X13 – change in the HRV in the first active test as compared to the first inactive test, X14 – change in systolic blood pressure in the last inactive test compared to with the first inactive test, X15 – change in diastolic blood pressure in the last inactive test compared to with the first inactive test. The threshold value is f = −0.21. If the patient's IM value is greater than the threshold value, the patient will belong to the CRS successful group. If the patient's IM value is less than the threshold value, the patient will belong to the CRS unsuccessful group.

Conclusion

the developed mathematical model allows predict the effectiveness of cardiorespiratory training in patients in early period of uncomplicated MI.
P2522A new scoring system to stratify post-surgical valvular patients during cardiovascular rehabilitation: derivation and validation study
Authors: Maranta F , Pistoni A , Cartella I , Cianfanelli L , Cerea P , De Bonis M , Castiglioni A , Alfieri O , Cianflone D
Published: October 2019

Background

Guidelines underline the importance of Cardiovascular Rehabilitation (CR) in post-surgical valvular patients both for the functional recovery and the monitoring of complications. However, there are no established indicators to better categorise their risk and to identify the real probability of recovery.

Purpose

The aim of this study is to propose and validate a scoring system to appropriately stratify post-surgical valvular patients in order to individualise CR programmes.

Methods

A retrospective study was conducted on 1480 post-surgical valvular patients hospitalized in our CR Unit (902 M – 578 F; median age of 64 years, IQR 53–73). 485 patients underwent single heart valve repair, 408 single heart valve replacement, 237 single heart valve surgery and additional interventions, 249 multiple valve interventions and 101 multiple heart valves and additional interventions. Subjects were randomised in two groups for data analysis: a Derivation (D; n=1000) and a Validation (V; n=480) group. Initially, in group D we assessed the predictive value of anamnestic, clinical and laboratory variables for major complications and functional recovery. We created two scoring systems for these outcomes and, subsequently, we validated them on group V. Finally, we interlaced them in an operative algorithm.

Results

Chronic kidney disease (OR 2.588; 95% CI 1.232–5.436; p=0.012), sternal surgical re-synthesis (OR 7.757; 95% CI 2.042–29.471; p=0.003), post-surgical transfusions (OR 2.419; 95% CI 1.407–4.161; p=0.001) and Troponin T peak >1400 μg/L (OR 2.441; 95% CI 1.418–4.200; p=0.001) were independent predictors for the occurrence of major complications in group D. Age (OR 0.958; 95% CI 0.9339–0.977; p<0.001), post- surgical transfusions (OR 1.981; 95% CI 1.160–3.380; p<0.001) and METS at admission (OR 0.032; 95% CI 0.017–0.061; p<0.001) were independent predictors of a higher functional recovery in group D. When the two scoring systems were validated on group V, we obtained a z score of 0.07 (p=0.941) for the major complications risk score and a z score of 1.23 (p=0.219) for the functional recovery stratification system, respectively, indicating a very reliable model. We proceeded to build an operative algorithm to stratify patients and propose personalised CR strategies.

Conclusions

We identified predictors to stratify the risk of complications and to define the probability of recovery in post-surgical valvular patients undergoing CR. The proposed final operative algorithm may be a unique tool to support the cardiologist to tailor rehabilitation programmes. This may lead to better outcomes and reduction of healthcare expenditure with optimisation in the use of available resources.

Acknowledgement/Funding

None
P2532Incidence and outcome of perioperative myocardial infarction/injury after non-cardiac surgeries diagnosed by high-sensitivity cardiac troponin I
Authors: Gualandro D M , Puelacher C , Hidvegi R , Cardozo F A , Marbot S , Yu P C , Vogt R , Calderaro D , Gueckel J , Strunz C , Bolliger D , Rentsch K , Caramelli B , Mueller C
Published: October 2019

Background

In order to differentiate perioperative myocardial infarction/injury (PMI) after non-cardiac surgery from preexisting cardiomyocyte injury from chronic disorders, recent studies have shown the importance of using an acute absolute increase as a criterion for PMI. For high-sensitivity troponin T (hs-cTnT), PMI defined as an absolute increase of 14ng/L (the 99th percentile) has been shown to be strongly associated with 30-day mortality. Until now, no data on hs-cTnI are available. This is a major unmet clinical need, as relevant differences between hs-cTnT and hs-cTnI have recently been identified and, as worldwide hs-cTnI is more commonly used as compared to hs-cTnT. We hypothesized that applying the same criterion to hs-cTnI, would reveal a similar association with outcomes.

Purpose

To evaluate the incidence and outcome of PMI diagnosed by hs-cTnI after non-cardiac surgery.

Methods

We included prospectively consecutive high cardiovascular risk patients undergoing non-cardiac surgery. Hs-cTnI concentrations were measured before surgery and, daily after surgery, for three days. PMI was defined as an absolute rise of ≥26ng/L (the 99th percentile of the assay studied) from baseline values. The primary outcome was major adverse cardiovascular events (MACE), a composite of cardiovascular death, myocardial infarction, acute heart failure and arrhythmias, and the secondary outcome was all-cause mortality, within 30 days and one year.

Results

We included 2,018 patients submitted to 2,551 surgeries. Patients had median age of 73 years (IQR 68–79) and 56% were male. After surgery, 231 patients (9%, 95% CI 8–10%) fulfilled PMI diagnostic criterion. Patients with PMI had higher rates of MACE than patients without PMI, at 30 days (13% vs. 2%; P<0.001) and, at one-year follow-up (25% vs. 8%; P<0.001). All-cause mortality was also higher in PMI patients within 30 days and one year (9% vs. 1.5% and, 22% vs. 8%, respectively; P<0.001). In multivariate cox regression analysis, PMI showed a hazard ratio (HR) of 4.7 (95% CI, 2.9–7.6; P<0.001) within 30 days, and a HR of 2.7 (95% CI, 2.0–3.7; P<0.001) within one year for the occurrence of MACE. For total mortality, PMI showed a HR of 3.8 (95% CI, 2.1–6.8; P<0.001) within 30 days and a HR of 2.0 (95% CI, 1.4–2.7; P<0.001) after one year.

Conclusion

PMI is frequent and associated with high rates of MACE and mortality in short- and long-term follow-up after non-cardiac surgery, regardless of the high-sensitivity troponin assay used for diagnosis.

Acknowledgement/Funding

Swiss Heart Foundation, University basel, Abbott, Astra zeneca, Forschungsfond Kantonsspital Aarau, Cardiovascular Research Foundation Basel, FAPESP
P2533Prospective randomized study on implanted cardiac rhythm recorders in pregnant women with symptomatic arrhythmia and/or structural heart disease
Authors: Viljoen C A , Sliwa K , Azibani F , Johnson M R , Baard J , Osman A , Briton O , Ntsekhe M , Anthony J , Chin A
Published: October 2019

Background

Cardiac arrhythmia is an important cause of maternal morbidity and mortality in pregnancy, but is difficult to diagnose.

Purpose

The aim of this single-centre, prospective, randomized pilot study was to compare the implantable loop recorder (ILR) with standard assessment of arrhythmia (12-lead ECG; 24-hour Holter ECG) in terms of acceptability, detection of arrhythmias and impact on outcome in pregnant women with symptomatic arrhythmias and/or structural heart disease (SHD).

Methods

The study recruited 40 consecutive patients from a weekly, dedicated cardiac obstetric clinic. Inclusion criteria: symptoms of arrhythmia and/or having SHD at risk of arrhythmia. Patients were randomized to either standard care (SC) or standard care plus ILR (SC-ILR). ILR recordings were read at the monthly visits and/or when presenting with symptoms.

Results

There were no demographic differences between the study groups. Seventeen patients consented to ILR insertion, all of whom found the procedure acceptable. No arrhythmias were recorded by the 12-lead ECGs. Holter monitoring detected arrhythmias in 10 of 23 patients (43%) from the SC group. In the SC-ILR group, 8 of 17 patients (47%) had arrhythmias detected by Holter, whereas 13 of 17 patients (76%) patients had arrhythmias detected by ILR (p=0.157). One of 4 patients with supraventricular tachycardia, 2 of 3 patients with premature ventricular complexes and 2 patients with paroxysmal atrial fibrillation (AF) recorded by ILR did not have the arrhythmias detected by Holter monitoring (Figure 1A shows a scatter plot of the variable R-R intervals seen in AF and 1B a rhythm strip of AF with irregular RR intervals and the absence of P waves, both downloaded from the ILR). Four of these 5 patients (80%) had a change in management as a direct result of their ILR recordings. There were no maternal deaths up to 42 days postpartum in either of the study groups. Nine babies were born with a low birthweight (<2500g), 5 stillbirth/neonatal deaths and 1 pregnancy termination occurred (5 in the Holter group and 1 in ILR group, p=0.37).

Figure 1

Conclusion(s)

This study suggests that an ILR is an acceptable diagnostic modality in pregnant women with a suspected or at risk of arrhythmia. The ILR increased the diagnostic yield to detect arrhythmias that were not detected by routine ECG and Holter monitoring which led to a change in management in the SC-ILR group and was associated with better maternal and neonatal outcomes. The impact of ILR monitoring should be further assessed in larger studies with longer follow up.
P2534Prevalence and risk factors of acquired LQTS among pregnancy: a single-center study
Authors: Han D , Sun C F , Li G L
Published: October 2019

Background

Prolonged QT intervals have been observed in pregnant women, especially those with twin pregnancy, which predisposes them to a high risk of ventricular arrhythmias.

Purpose

To evaluate the prevalence of acquired long QT syndrome (aLQTS) in hospitalized parturient women with single and twin pregnancy and search for potential risk factors.

Methods

Information about age-matched parturient women with single and twin pregnancy were retrospectively collected in our hospital from January 2016 to June 2018. The prevalence of aLQTS was evaluated. The common risk factors for corrected QT (QTc) prolongation were compiled, and multivariable logistic regression analysis was used to evaluate how each factor was related to aLQTS in such population.

Results

Totally 293 parturient women (147 twin pregnancy, 50.17%) were included. The prevalence of aLQTS was 72.70% in all cases, 53.15% in the single pregnancy, 93.20% in the twin pregnancy. The proportion of severely prolonged QTc was 36.18% in all cases, 8.22% in the single pregnancy and 63.95% in the twin pregnancy. The QTc interval was much longer in the twin pregnancy than in the single pregnancy with significant difference. Differences in systolic blood pressure, diastolic blood pressure, total cholesterol, serum uric acid, fetal weight, QRS, RV5+SV1, Tp-Te, Tp-Te/QT have been revealed to be statistically significant between the QTc-prolongation group and the QTc-normal group. The incidence of gestational hypertension and twin pregnancy in the QTc-prolongation group were more prevalent than in the QTc-normal group with significant difference. In the multivariable logistic regression analysis, gestational hypertension, twin pregnancy, increase of diastolic blood pressure, high total cholesterol, high serum uric acid, and heavy fetal weight were identified to be associated with QTc prolongation in parturient women.

Table 1. Risk factors significantly correlated with QTc prolongation in parturient women Index P value OR (95% CI) DBP (mmHg) 0.033* 1.052 (1.004 to 1.101) TC (mmol/L) 0.001** 1.442 (1.165 to 1.785) UA (μmol/L) 0.007** 1.004 (1.001 to 1.008) Fetal weight (g) <0.001** 1.001 (1.001 to 1.001) Hypertention (%) 0.029* 2.561 (1.099 to 5.967) Twin (%) <0.001** 12.618 (6.145 to 25.909)

Conclusion

To our knowledge, this is the first clinical study to evaluate the prevalence of aLQTS between single and twin pregnancy. The prevalence of aLQTS is much higher in the parturient women, particularly in twin pregnancy.
P2544Acute effects of synthetic cannabinoids on ventricular repolarization parameters
Authors: Yildiz S S , Sutasir N , Sigirci S , Topcu H , Kilickesmez K
Published: October 2019

Bacground

The association between ventricular repolarization parameters (VRP) and ventricular arrhythmias has been shown in previous studies. However, there are limited data on the association between synthetic cannabinoids (SCs) and VRP.

Purpose

To analysis the acute effects of SCs on VRP by using T-peak to T-end (Tp-e) interval, Tp-e/QT ratio and Tp-e/QTc ratio.

Methods

The present study included 58 patients who admitted to the emergency department and who used of SC (SC+) during the years 2014–2016, and 50 healthy control subjects (SC−). QT and QTc intervals, Tp-e interval, Tp-e/QT and Tp-e/QTc ratios were measured from the 12-lead electrocardiogram in all subjects. Then, this parameters were compared between the groups and were performed correlation analysis.

Results

The Tp-e and QTc intervals were significantly higher in SC+ when compared to SC- (92.2±10.0, 77.4±9.3, p<0.001; 434.5±30.8, 410.9±27.3, p<0.001, respectively). Tp-e/QT and Tp-e/QTc ratios were increased in SC+ in comparison to SC− (0.26±0.02, 0.22±0.02, p<0.001; 0.21±0.02, 0.18±0.02, p<0.001, respectively). Significant correlations were found between use of SC and Tp-e interval (r=0.610, p<0.001), Tp-e/QT (r=0.655, p<0.001) and Tp-e/QTc ratios (r=0.437, p<0.001).

Table 1. Electrocardiographic findings in between SC+ group and SC− group. SC+ group (n=58) SC− group (n=55) p value QRS duration (ms) 92.6±8.2 90.1±7.9 0.492 QT (ms) 348.4±29.0 353.4±30.7 0.301 QTc (ms) 434.5±30.8 410.9±27.3 <0.001 Tp-e (ms) 92.2±10.0 77.4±9.3 <0.001 TPe/QT ratio (ms) 0.26±0.02 0.22±0.02 <0.001 TPe/QTc ratio (ms) 0.21±0.02 0.18±0.02 <0.001

Conclusion

The present study revealed that Tp-e interval, Tp-e/QT and Tp-e/QTc ratios increased in subjects who used SC. Therefore, SC users might have an increased risk of ventricular arrhythmia.
P2546The treegenes study: psycho-trauma and cardiovascular impact in offspring
Authors: Barth J D , Van Beurden-Cahn M M
Published: October 2019

Introduction

The TreeGenes study assesses health, chronic psycho-trauma, and disease in three Dutch post-Holocaust generations. It has been shown before that chronic psycho-trauma accelerates atherosclerosis and Post Traumatic Stress Disorder (PTSD) offspring shows signs of both increased cardiovascular morbidity and mortality. Hypothesis: PTSD offspring lacks adequate specialized medical intervention.

Methods

Mental health problems play an important role in this group and may contribute to chronic diseases. Therefore, we studied disease management in this group with a focus on cardiovascular disease (CVD). Cases and controls were randomly drawn from the TreeGenes database. Extensive personalized interviews and assessment of CVD were done non-invasively (heart rate variability, ECG, blood pressure and saturation assessment). In addition, risk factors and medication were noted.

Procedures

38 Cases of PTSD offspring were assessed for CVD as well as other chronic diseases in an outpatient setting.

Results

Most study cases were suffering from chronic and active diseases: notably hypertension, CVD, gastrointestinal diseases as well as mental problems. All cases were seen by local family physicians and a psychological/psychiatric support system. Cases that were suffering from CVD were treated according to routine treatment protocol standards. Medical care was considered adequate by health care professionals standards.

Study characteristics TreeGenes participants (n) Study group Controls Significance level Age in years (range) 65 (61–73) 62 (58–70) Active CVD 32/38 2/38 p<0.01 Hypertension medication 28/38 4/38 p<0.01 Lipid problem medication 31/38 6/38 p<0.01 Arrythmia 10/38 2/38 p<0.01 Smoking 2/38 1/38 ns Psychotropic medication 38/38 4/38 p<0.001 ns, not significant; psychotropic medication: anxiolitics, antidepressants and major psychotropic medication; CVD, cardiovascular disease, n, number.

Conclusion

The results (table 1) from the two groups are significantly different though matched for age and gender. Given the extra care offered to this offspring group, successful treatment of the underlying diseases should have been better. Given the poor success rate of routine protocol assessment, specialized training should be given to medical personnel involved. These results demand further investigation in similarly affected populations.

Acknowledgement/Funding

Jeremiasz Foundation
P2554Bleedings during antithrombotic therapy: a blessing in disguise
Authors: Cosmi D , Mariottoni B , Cosmi F
Published: October 2019

Background and purpose

Antithrombotic therapy in patients with heart diseases is associated with minor and major, sometimes fatal bleedings. On the other hand, bleeding can favor the diagnosis of diseases that have a significant impact on patient's prognosis. In our research, we evaluated the incidence of occult malignancies associated with bleeding during antithrombotic therapy.

Methods

In the last 5 years, we evaluated 20,154 outpatients. We found that antithrombotic therapy was performed in 9.356 (46%) of subjects.

Of these, 6,560 took an antiplatelet monotherapy. 658 were on dual antiplatelet therapy, 465 were anticoagulated with warfarin, 1,154 received new anticoagulants, 145 were on triple antithrombotic therapy, and 354 patients took one anticoagulant plus an antiplatelet.

Twenty patients who already had a diagnosis of malignancy were excluded from the analysis. In a one year follow-up, we evaluated the incidence of minor, major and fatal bleedings.

All patients with bleedings and suspicion for occult malignancies underwent further diagnostic investigations.

Results

Table 1 shows the incidence of bleeding (classified according to the ISTH bleeding score). Overall, there were 1,045 bleeds, of which 289 (3.1%) were major, and 756 (8.1%) minor. In 2 cases the bleeding was fatal (0.2%).

Malignancies were identified in 88 patients (8.4%); in 72 cases (82%) the treatment was resolutive.

Table 1. Rates of major and minor bleedings and occult malignancies Bleedings Major Occult malignancies Minor Occult malignancies Gastrointestinal 130 (1.4%) 15 (5.1%) 289 (3.1%) 45 (6.0%) Urinary 46 (0.5%) 6 (2.1%) 207 (2.2%) 14 (1.8%) Musculo-cutaneous 30 (0.3%) – 47 (0.5%) Epistaxis and airways 36 (0.4%) – 198 (2.1%) 8 (1.0%) Intracranial 28 (0.3%) – – – Ocular 9 (0.1%) – 15 (0.2%) – Intraarticular 10 (0.1%) – – – Others – – – Total 289 (3.1%) 21 (7.2%) 756 (8.1%) 67 (8.8%)

Conclusions

Our research underlines the importance of prosecuting diagnostic investigations even in patients with minor bleedings, especially in case of gastrointestinal or urinary bleedings, to exclude cancer, since there were no significant differences in the incidence of malignancies between the two groups.
P2557A novel tool for light sheet-guided analysis of myocardial injury in murine and human samples
Authors: Korste S , Merz S F , Bornemann L , Michel L , Stock P , Hendgen-Cotta U , Rassaf T , Gunzer M , Totzeck M
Published: October 2019

Background

Cardiovascular diseases are the most prominent global health threats. For optimal treatment, myocardial biopsies are an indispensable requirement. Current analysis includes histological and biochemical assays with particular limits. Here we present a first approach utilizing light sheet fluorescence microscopy (LSFM) to visualize the 3D vasculatory architecture in the murine heart after experimental myocardial infarction (MI) and in human cardiac biopsies with simultaneously imaging of various immunological infiltrates for disease investigation.

Methods and results

For murine hearts, cardiac vasculature was stained using CD31-AF790 antibody, where we found distinct spots of negative staining, which correlated in size and localisation with other markers of cardiac damage such as triphenyl tetratzolium chloride (TTC) staining, ejection fraction (EF) reduction and plasma cardiac troponin I levels. Using a Ly6G-AF647 antibody, we were able to visualize neutrophil infiltrates 24 h after MI, which localized at the border of the I/R-injury zone. 5 d after MI we imaged the healing vasculatory network using the CD31 marker as well as infiltrated macrophages using F4/80 staining.

Human cardiac vasculature was stained using CD31-AF790 antibody in a whole-mount staining approach. In short, human samples were fixed in 4% PFA and permeabelized using saponin-based detergents. Antibody staining was conducted at 30 °C in the dark over several days. Immunological infiltrates were visualized using human CD66b, CD16, CD64, CD3 and CD19 antibodies in various, simultaneous approaches. After staining, cardiac samples were dehydrated and cleared using ethyl cinnamate (ECi) for light sheet microscopy. The spatial resolution of cardiac blood vessels was determined by CD31 staining, revealing a highly organized and structured vascular tree. Simultaneous staining for immunological infiltrates showed association with areas of enhanced CD31 staining, displaying activated endothelium at sites of inflammation.

Ly6G events in a murine heart

Conclusion

Light sheet-guided analysis of cardiac samples shows promising results in terms of synchronous vascular and immunological investigation. We highlighted its applicability in identifying specific immune cells based on immune-phenotyping. This novel technique may enable future clinical heart disease investigation with a powerful tool for visualization of 3D cardiac structure and identification of multiple immune cell infiltrates.
P2562Changes in the electrocardiographic/mechanical relation may explain the low risk of arrhythmia during moderate hypothermia
Authors: Wisloff-Aase K , Skulstad H , Halvorsen P S , Fiane A E , Espinoza A
Published: October 2019

Introduction

Hypothermia is therapeutically used after cardiac arrest. The moderate hypothermia alters cardiac function, with reduced heart rate (HR), prolonged systolic duration and increased QT interval. The risk of arrhythmia increases with prolonged QT-interval, but clinical studies have not been able to demonstrate an increase of arrhythmic events during moderate hypothermia. The mechanism of this is not thoroughly described, but the concurrent increase in mechanical systolic duration may play a part of the explanation.

Purpose

QT prolongation and increased electromechanical window (EMW) negativity; the duration of left ventricle mechanical systole relatively to the duration of the electrical systole, are associated with arrhythmia. We hypothesized that moderate hypothermia would increase ECG intervals and systolic duration without an increase in EMW negativity.

Methods

In an open-chest porcine model (n=10), 2D echocardiography measurements and Doppler recordings were performed with concurrent 3-lead ECG registrations during normothermia (38°C) and moderate hypothermia (33°C) at spontaneous HR. Diastolic and systolic durations were assessed by valve opening to valve closure and Doppler assessed ejection time (ET). Isovolumetric contraction time (IVCT) and EMW, were measured. Systolic function was assessed by ejection fraction (EF), stroke volume (SV) and systolic velocity (s'). Results are presented as means ± SD. Two-sided T-test was used for comparison and P-value <0.05 was considered significant.

Results

Moderate hypothermia reduced HR from 91±9 to 82±7 beats/min (p<0.0001) and increased QT and QT-corrected (QTc) intervals, the latter from 484±52 to 555±50 ms (p<0.0001). Systolic duration increased as ET was prolonged from 293±15 to 397±39 ms (p<0.0001). There was a reduction in systolic velocity (s') (p=0.003) but a non-significant reduction in EF and SV. EMW changed from a negative to a positive value, −49±57 to 9±53 ms (p=0.017) during moderate hypothermia.

Conclusion

Moderate hypothermia increased the QTc-interval but the mechanical systolic duration was even more prolongated. The EMW became positive demonstrating that the mechanical systole outlasted the electrical systole. As less EMW negativity is considered to be protective regarding arrhythmia, these findings may explain why arrhythmia is not frequently occurring during moderate hypothermia.

Acknowledgement/Funding

None
P2565Decreased cardiac pacemaking and attenuated beta-adrenergic response in tric-a knock-out mice
Authors: Toyama Y , Yonekura M , Tomita H , Murakami M
Published: October 2019

Background

Trimeric intracellular cation (TRIC) channels are expressed on the surface of the sarcoplasmic reticulum and compensate for calcium release from ryanodine receptors. Tric-a knock-out (KO) mice showed diminished calcium release from ryanodine receptors in vascular smooth muscle cells. The cardiac pacemaker is controlled by the surface membrane and intracellular calcium clocks. In spontaneously firing sinus node action potentials, the membrane and calcium clocks work together via numerous interactions modulated by membrane voltage, intracellular calcium release, and protein phosphorylation. Intracellular calcium changes modulate cardiac pacemaking in the sinus node, but the physiological importance of TRIC channels in cardiac rhythm formation is still obscure.

Purpose

In this study, we aimed to clarify the importance of TRIC channels on cardiac pacemaking using Tric-a KO mice.

Methods

The expression level of mRNA and proteins in the sinus node was examined by RT-PCR and immunoblotting. Systolic blood pressure was measured with tail-cuff method. Heart rate was measured by ECG, and heart rate variability was examined. The atrial contractile force from isolated hearts was measured with a force transducer. Cardiac action potential and spontaneous sinus rate from isolated hearts were measured with a microelectrode. Isoproterenol was used for sympathetic nerve manipulation.

Results

Tric-a KO heart showed increased adrenergic β1-receptor expression in immunoblotting. Although there was no significant difference in basal systolic blood pressure between Tric-a KO and wild type (WT) mice, basal heart rate in Tric-a KO mice was significantly lower than that in WT mice (660±10 and 698±10 bpm, n=15 and 19, Tric-a KO mice and WT mice, respectively, p=0.017). Tric-a KO mice showed limited heart rate changes to isoproterenol (24±6 and 99±15 bpm, n=9 and 10, Tric-a KO mice and WT mice, respectively, p<0.001). In the action potential recordings, Tric-a KO atria showed only limited sinus rate changes to isoproterenol (35±9 and 71±10 bpm, n=8 and 6, Tric-a KO mice and WT mice, respectively, p=0.038). WT mice and Tric-a KO mice atrial contractile force showed dose-dependent changes in response to isoproterenol (10–100 nM), but Tric-a KO mice atria showed limited contractile force changes to isoproterenol (116 and 169%, n=7 and 6, Tric-a KO mice and WT mice, respectively, p<0.01). In heart rate variability, Tric-a KO mice showed unstable RR intervals and longer standard deviation of RR intervals than WT mice.

Conclusion

Tric-a KO mice showed decreased cardiac pacemaking in the sinus node and attenuated responses to beta-adrenergic stimulus, which indicates the involvement of TRIC channels in cardiac rhythm formation and sympathetic nerve regulation.
P2579Experience of application in Russia pulsoxymetry as screening for detecting critical states in the newborns: critical congenital heart defects and pulmonary hypertension
Authors: Kustova N , Sadykova D R , Sabirova D R , Babintseva A A
Published: October 2019

Despite the improvement in the last decades of prenatal ultrasound diagnosis and clinical examination of newborns, even in countries with developed health care, up to 28% of newborns with critical congenital heart defects (CHD) are discharged from the hospital without a diagnosis. Early detection of persistent pulmonary hypertension in newborns (PPHN) is often associated with certain difficulties, which leads to a delayed diagnosis of this syndrome and a later start of therapy.

Objective

To improve the methods of diagnosing the early detection of newborns with hypoxemia due to critical CHD or persistent pulmonary hypertension of the newborn, as well as to achieve a reduction in infant mortality.

Materials and methods

During the study period – from April 2017 to February 2018 using the developed algorithm for performing screening of critical conditions in newborns using pulse oximetry, 8,358 newborns were examined on the basis of maternity hospitals of the Republic of Tatarstan, which accounted for 88.4% of 9459 births registered. A modified two-band pulse oximetry technique was used, followed by echocardiography of the newborn with a positive screening result.

Results

The introduction of pulse oximetry screening in the early neonatal period (3rd hour of life) allowed the timely detection of 95 children with a positive test result, whose conditions caused the greatest risk to the health of newborns, which accounted for 1.14% of all children studied. Thanks to the screening, in 13 newborns in the first hours of life, congenital heart defects that were not diagnosed in utero were detected, 5 of them were critical. Persistent pulmonary hypertension was detected in 20 patients. Intrauterine pneumonia was diagnosed in 30 newborns. Among the critical CHDs, the following diagnoses were established: transposition of the great vessels – 2 children, aortic coarctation – 1 child, total abnormal pulmonary vein drainage – 1 child, Taussin-Bing anomaly – 1 child. Evaluation of the effectiveness of the screening showed that a positive result had a decisive role in the timely diagnosis of critical CHD and persistent pulmonary hypertension of the newborn.

Conclusions

Pulse oximetry helps to identify both systemic hypoxemia and postductal desaturation, which is characteristic of both critical CHD and PPHN, and can be used to screen newborns for these conditions. Pulse oximetry is an easily accessible, non-invasive, painless method that can be included in a regular examination of the newborn. The advantages of pulse oximetry also include simplicity and short procedure time.
P2608Impact of sub-clinical systolic dysfunction on exercise hemodynamics in HFpEF: time to integrate diastolic and systolic indices
Authors: Nanayakkara S , Telles F , Beale A M , Evans S , Vizi D M , Marwick T , Kaye D M
Published: October 2019

Background

A potential role for subclinical systolic impairment as a contributor to the pathophysiology and outcomes of heart failure with preserved ejection fraction (HFpEF) has been proposed recently. However, the precise relationship of indices of systolic dysfunction with exercise hemodynamics in HFpEF is not known. In this study, we characterize the relationship between left ventricular mechanical function assessed by strain imaging with the key hemodynamic features of HFpEF at rest and during exercise.

Methods

Simultaneous echocardiography and exercise right heart catheterization was performed in 90 subjects (68 HFpEF, 22 control) referred for assessment of dyspnea. HFpEF was defined as left ventricular ejection fraction (LVEF) ≥50% with a pulmonary capillary wedge pressure (PCWP) ≥15mmHg at rest and/or ≥25mmHg at maximal exertion. Measures of left ventricular strain were taken using speckle tracking and analyzed together with natriuretic peptides and rest and exercise hemodynamics.

Results

At rest, HFpEF patients had impaired GLS compared to NCD subjects (−18.4±2.5 vs −21.2±3.5%, p≤0.001. Ejection fraction was similar (62±6 vs 61±6%, p=0.81). With worsening global longitudinal strain, patients with HFpEF displayed a worse cardiac index at both rest and exercise (p<0.001 for both), but similar filling pressure (p=0.85). The tertile with the worst strain had the highest level of natriuretic peptide. The association of strain with peak cardiac index was independent of LVEF, BNP, age, LAVI, LVMI, and systolic blood pressure.

Conclusions

Despite a preserved ejection fraction, a proportion of patients with HFpEF display impaired GLS, which correlates with a worse cardiac output. Impaired GLS was not associated with higher filling pressures at rest or exercise.

Acknowledgement/Funding

National Heart Foundation of Australia
P2612Anaemia and renal impairment in heart failure: prevalence and differential prognostic importance according to the AHA ACC heart failure classification
Authors: Kordsmeyer M , Gueder G , Stoerk S , Edelmann F , Wachter R , Pankuweit S , Pieske B , Prettin C , Ertl G , Angermann C
Published: October 2019

Background

Anaemia (A) and renal impairment (RI) are frequent comorbidities in heart failure (HF) and known to impact adversely on outcome.

Purpose

In this post-hoc analysis, we allocated HF patients from 4 studies of the Competence Network Heart Failure at baseline to subgroups according to American Heart Association/ American College of Cardiology (AHA/ACC) HF criteria and compared prevalence rates of A and RI at each HF stage and the individual and cumulative long-term impact of these comorbidities on all-cause mortality (ACM) over a 5-year follow-up (FUP) period.

Methods

To study A and RI prevalence, we performed a cross-sectional analysis in 3344 patients (40.6% female, 65.6±11.2 years, 7.8, 32.3, 38.5, and 21.4% in stages A, B, C1 and C2/D, respectively). FUP data were available for 2496 patients (37.4% female, 66.0±11.3 years, 8.1, 35.3, 32.9, and 23.7% in stages A, B, C1 and C2/D, respectively). A was defined as haemoglobin <13/12 g/dL in men/women and RI as estimated glomerular filtration rate <60 mL/min/1.73m2. Within each HF subgroup, participants were divided in those without these comorbidities (A-/RI-), with either A or RI (A+/RI- and A-/RI+), or with both, A and RI (A+/RI+). For survival analysis log rank tests and multivariable Cox regression models were used.

Results

Overall prevalence of A in the stages A, B, C1, and C2/D was 3.1, 7.6, 16.5, and 29.8% (p<0.001) and of RI 17.6, 21.3, 24.4, and 46.6% (p<0.001), respectively. In the 4 subgroups, prevalence rates of A-/RI- were 80.2, 74.3, 66.3, and 42.1%, (p<0.001). A+/RI- and A-/RI+ were present in 2.3, 4.4, 9.3, and 11.3% (p<0.001) and 16.8, 18.1, 17.2, and 28.1 (p<0.001). A+/RI+ was found in 0.8, 3.1, 7.1, and 18.5% (p<0.001). Kaplan Meier curves demonstrate the individual and cumulative prognostic impact of A and RI (Figure).

Conclusions

Our results demonstrate a high prevalence in particular of RI even in asymptomatic HF stages and significant individual and cumulative long-term adverse effects of A and RI across the entire HF continuum. This includes also the clinically asymptomatic HF stages. Both prevalence and the individual and cumulative negative prognostic impact increase with increasing HF severity calling for careful consideration and management of these comorbidities in the frame of holistic HF care.
P2618Association of left ventricular ejection fraction with mortality and hospitalizations
Authors: Angaran P , Dorian P , Ha A , Thavendiranathan P , Tsang W , Leong-Poi H , Woo A , Dias B , Wang X , Austin P , Lee D
Published: October 2019

Background

Although 2-dimensional echocardiography (2DE) is widely used to measure left ventricular ejection fraction (LVEF), the prognostic value of 2DE-derived LVEF has not been clearly demonstrated in a broad range of patients, including those acutely hospitalized as well as ambulatory patients. In particular, the prognostic value of echocardiographic LVEF has not been demonstrated for cardiovascular and heart failure hospitalizations.

Purpose

To determine if greater degrees of LV dysfunction are associated with progressively increasing risks of death or cardiovascular hospitalizations among patients undergoing echocardiography in hospital or outpatient settings.

Methods

We examined quantitative LVEFs from patient-level echocardiographic reports at 3 large hospital laboratories, which were linked to the Canadian Institute for Health Information hospitalization database and to death registries in Ontario, Canada. LVEF was categorized as <25%, 25–35%, 36–45%, or 46–55% (reference). Analyses were performed using cause-specific hazard competing risk models and stratified by: a) outpatient vs. inpatient echocardiogram, and b) if inpatient study, whether the reason for hospitalization was cardiac or noncardiac in nature.

Results

In the echocardiographic cohort of 27,323 patients (median age 68 [IQR: 58–77], 14,828 women [31.7%]), greater reductions in LVEF were associated with higher rates of all-cause mortality, with adjusted hazard ratios (95% CI) of 1.67 (1.57, 1.77) for LVEF <25%, 1.30 (1.24, 1.36) for LVEF 25–35%, and 1.17 (1.11, 1.23) for LVEF 36–45%, compared to LVEF 46–55% (all p<0.001). The cumulative incidence of cardiovascular death was higher as LVEF progressively worsened (Figure). The rate of heart failure hospitalizations was also increased with hazard ratios of 1.71 (1.59, 1.85) for LVEF <25%, 1.39 (1.31, 1.48) for LVEF 25–35%, and 1.21 (1.13, 1.29) for LVEF 36–45%, compared to LVEF 46–55% (all p<0.001). Cardiovascular hospitalizations were also increased with hazard ratios of 1.35 (1.27, 1.42), 1.21 (1.16, 1.27), and 1.13 (1.07, 1.18) for LVEFs <25%, 25–35%, and 36–45%, respectively (all p<0.001). The risk of mortality and hospitalizations increased comparably with greater reductions in LVEF during both inpatient cardiac or noncardiac admissions (p<0.001).

Cumulative incidence of CV death

Conclusions

Quantitative LVEF assessed by 2DE is potent prognostically and was able to stratify the risk of both death and hospitalization outcomes in a wide range of clinical settings. Patients with reduced LVEF measured on inpatient or outpatient echocardiograms, and even in the context of non-cardiac admission, should be considered an at-risk group in whom quality of care metrics could be evaluated in future studies.

Acknowledgement/Funding

Canadian Institutes of Health Research, Heart and Stroke Foundation, and the Ted Rogers Centre for Heart Research
P2626Outcome of patients in cardiogenic shock supported with a micro-axial blood pump providing 5 l/min blood flow
Authors: Nersesian G , Spillmann F , Gromann T , Tschoepe C , Schoenrath F , Stark C , Falk V , Potapov E V
Published: October 2019

Introduction

Percutaneous mechanical circulatory support devices are increasingly used in acute cardiogenic shock (CS), despite limited evidence for their effectiveness. The aim of this study was to evaluate outcomes associated with use of the full support Impella 5 and 5.5 as a short- term left ventricular device (LVAD) and to identify preoperative predictors of short -term mortality.

Methods

Data of patients in CS (n=51) treated with the Impella 5 (n=48) and 5.5 (n=3) devices at our institution were collected retrospectively. The primary endpoint was 30-day all-cause mortality. Clinical follow up including adverse events was analyzed.

Results

Mean age was 58.2±12.1 years; 80.4% were male. 13 patients had BMI >30 kg/m2. CS was caused by acute myocardial infarction (n=14), decompensated chronic heart failure (n=29), postcardiotomy syndrom and acute myocarditis (n=4 each). Before implantation, median Intermacs profile was 1 (range 1–3) and 31 patients (61%) were on respiratory support. In 49 patients the axillary artery was used for vascular access (n=4 left and n=45 right) employing a 10mm dacron graft tunneled through the skin, in one patient left femoral artery and ascending aorta, respectively. Median support time was 14 days.

In 12 cases the pump was removed for myocardial recovery. In 15 patients a continuous flow permanent LVAD was implanted. Bleeding (n=9), thromboembolic event (n=5), pump dislodgement (n=7) requiring revision occurred during support. Seven patients developed ventricular arrhythmia requiring flow reduction. In 5 cases the pump was explanted for hemolysis, in 2 other patients pump exchange was performed. The overall 30-day survival was 53% (95% CI: 38.8–67.1%). Penalized multivariable logistic regression analysis identified preoperative elevated lactate (p=0.027) and CK-MB (p=0.022) as predictors for 30- day mortality. On the basis of these data, a nomogram to estimate 30d-mortality after Impella implantation was created.

Conclusion

Stabilization of patients suffering from CS employing temporary full support Impella LVAD is feasible and results in acceptable survival. Preoperative degree of shock and myocardial damage predict the short-term mortality. Effect of full support Impella LVAD in earlier stages of shock may prevent irreversible end organ damage.
P2628Predicting cardiac recovery before durable left ventricular assist device implantation in advanced heart failure patients
Authors: Taleb I , Horne B D , Yin M Y , Nativi-Nicolau J , Wever-Pinzon O , McKellar S H , Caine W , Koliopoulou A G , Alharethi R , Kfoury A G , Gilbert E M , Fang J C , Stehlik J , Selzman C H , Drakos S G
Published: October 2019

Background

Predicting cardiac recovery (CR) in advanced heart failure (HF) patients before left ventricular assist device (LVAD) implantation remains challenging. This study sought to investigate whether CR after LVAD unloading can be predicted by cardiac functional and structural parameters together with clinical characteristics.

Methods

From 2008 to 2016, consecutive advanced chronic HF patients (N=347) supported with durable continuous-flow LVADs were prospectively evaluated. Patients with acute HF etiologies or without adequate post-LVAD follow up (<3 months) were excluded. A great variety of clinical characteristics were evaluated in the remaining 285 subjects. LVAD patients were phenotyped while on support, as CR Responders or Non Responders, based on published predefined echocardiographic criteria. Multivariable logistic regression was used to form the model and the Utah Cardiac Recovery (UCAR) score was created from the regression beta coefficients of the final model.

Results

CR occurred in 13.7% of patients. Univariate analysis showed that responders were more likely to be young, female, non-ischemic cardiomyopathy, with shorter HF symptoms duration and no prior cardiac surgery. They had lower blood urea nitrogen and were more likely to be on temporary mechanical support before LVAD. The multivariable UCAR model (AUC=0.755; p<0.001) predicted CR using 3 clinical parameters – Figure.

Conclusion

Univariate and multivariable predictors of CR include both modifiable and non-modifiable patient characteristics that are known prior to LVAD implantation. The UCAR score can serve as a practical tool for targeted patient selection to implement protocols that facilitate CR in the advanced HF patient subpopulation that is most likely to respond.