bluuebunny/crossref_metadata_2025 huggingface dataset:
P2279First clinical evaluation of subcutaneous implantable cardiac defibrillator in Brugada patients
Authors: Probst V , Clerici G , Babuty D , Badenco N , Marquie C , Leenhardt A , Maury P , Blangy H , Deharo J C , Tfelt-Hansen J , Rudic B , Behar N , Mansourati J , Sacher F , Gourraud J B
Published: October 2019

Background

Brugada syndrome (BrS) is an inherited arrhythmia syndrome with an increased risk of SCD. While Subcutaneous ICD (S-ICD) is a seductive approach to treat these patients, questions raised on the risk of inappropriate shock in this specific population.

Objective

The aim of this study was to evaluate the safety and the effectiveness of the S-ICD in BrS patients.

Methods

We prospectively enrolled 112 BrS patients implanted with S-ICD in 17 European centers. During the screening at least 2 vectors must be suitable but it was not necessary to check for the suitability of the ECG during sodium channel blocker or exercise test. S-ICD indications follow the current guidelines.

Results

Mean age of patients was 45±13 years, with 95 (85%) males. Implantation was performed in 91 (83%) patients for primary prevention and in 18 (16%) patients for secondary prevention. There is an indication of ICD replacement for 16 patients (14%): 13 lead defect (81%), 1 infection (6%) and 2 ICD end of life (13%). In this cohort, 57 patients (51%) had spontaneous type I BrS, 60 patients (55%) were symptomatic: 10 resuscitated SCD (17%) and 48 (83%) syncope.

Implantation was performed under general anesthesia in 79 patients (71%). The mean operation time was 56±19 min. The lead was placed at the left side of the sternum in 102 patients (92%) and at the right side in 9 (8%). Sensing configuration was the primary vector for 46 patients (41%), secondary vector for 57 (51%) and alternative vector for 9 (8%). No complications occurred during implantation.

During a mean follow-up of 15.6 months (0–39 months), 6 patients (5%) had at least one appropriate shock (n=9). The rate of appropriate shock was 4.5%/y. All the VF episodes were successfully treated with the first shock. One patient had VF ablation for recurrent VF. Among the 6 patients who received an appropriate shock, 3 (50%) were implanted for secondary prevention and 3 (50%) were implanted for primary prevention including 2 patients with a history of syncope and one asymptomatic patient.

Twelve patients (11%) had at least one inappropriate shock (n=22) including 2 patients with respectively 8 and 4 inappropriate shocks due to T-wave oversensing. With the SMART pass system the first patient had no more inappropriate shock for now 2 years. The rate of inappropriate shock was 9%/y. One patient died of myocardial infarction.

Five patients (4%) were hospitalized for complications (4 pocket or scar infections and 1 electrode failure).

Conclusion

Our initial experience showed that S-ICD is efficient to treat VF episode in BrS patients. In this population, the rate of inappropriate shock was 9%/y. In view of these results, S-ICD implantation seems to be efficient to protect BrS patients against SCD.

Acknowledgement/Funding

Investigator-Sponsored Research program, Boston Scientific
P2435Non-invasive thermal imaging identifies left ventricular remodeling in mice
Authors: Brzezinski R Y , Ovadia-Blechman Z , Lewis N , Zimmer Y , Levin-Kotler L , Shaihov-Tepper O , Naftali-Shani N , Tsoref O , Grossman E , Leor J , Hoffer O
Published: October 2019

Purpose

Thermal infrared imaging is a non-invasive tool with the potential to screen physiological processes and diseases. The use of this technique to image internal organs, such as the heart, has not yet been investigated. We aimed to determine the ability of a novel algorithm for thermal image-processing to detect structural and functional changes in a mouse model of cardiac remodeling.

Methods

We randomized 12 male mice (weight 20–25 gr) to treatment with either angiotensin-II (2 mg/kg/day, n=6) or saline (n=6) pump-infusion for 28 days. We measured blood pressure weekly, together with serial trans-thoracic echocardiography studies and histopathological evaluation of the hearts. We captured thermal images with the commercially available FLIR One camera, and processed images by our novel algorithm.

Results

Angiotensin infusion increased blood pressure together with cardiac hypertrophy and fibrosis. Thermal imaging identified an increase in the fraction of the skin heated by the heart in angiotensin-treated mice, at day 28 of the experiment. Thermal image findings were correlated to left ventricular mass and volume by echocardiography (r=0.6, p=0.07 and r=0.8, p<0.01). By thermal imaging, all angiotensin-treated hearts displayed a unique triangle-like shape of heat distribution. This finding was absent in controls, indicating remodeling in the hypertensive heart.

Visual Abstract

Conclusion

Our preliminary findings suggest, for the first time, that a thermal camera with a new image-processing algorithm, identifies cardiac structural changes in mice. Our findings propose a new, simple, and non-invasive tool to diagnose and monitor adverse cardiac remodeling.
P2436Preliminary data from “LAA-Print French registry”: a large national multi-centric prospective registry evaluating a new preoperative approach based on 3Dprinted simulation in LAAC procedures
Authors: Ciobotaru V , Combes N , Iriart X , Marijon E , Hascoet S , Nguyen A , Ternacle J , Defaye P , Jacon P , Lepillier A , Thambo J B , Teiger E , Cheneau E , Commeau P , Elbaz M
Published: October 2019

Left atrial appendage closure (LAAC) is an alternative to OAC in patients with contra indication to OAC and AF. But LAAC may be at risk, especially in frail patients.

There are no imaging criteria to asses individual procedural risk.

Furthermore, procedural factors (double curve catheter alignment) are hard to predict

3D-printing simulation has capability to integrate all anatomical and procedural parameters and has demonstrated improvements in LAAC device sizing in a pilot study

Aim

To demonstrate efficiency of 3D-printing simulation to predict LAAC procedural risk (failure, long procedure time, pericardial effusion or others serious adverse events (SAES) or inappropriate implantations)

Methods

Open study: Prospective and Consecutive.

Recruiting 150 patients in 16 centres (of 300 patients expected).

Start: Jan 18th, 2018.

Study Completion: Nov 1st, 2019.

ClinicalTrials ID: NCT03330210.

1. Cardiac CT prior to LAAC.

2. Industrial manufacture, laser sintering, of 3D-printed models including the whole LA cavity including interatrial thin septum and vena cava (using material TPU with adequat elasticity: shore 50).

3. LAAC Simulation based on 3Dprinted models using specific sheaths and prosthesis.

Prior to LAAC procedure each operator asses a risk score for procedural failure (low/moderate/high) based on real 3D printed LAAC simulation taking into account: trans-septal puncture site/sheath alignment with LAA ostium/device deployment and stability.

4. LAAC procedure TEE guided.

5. CT or TEE control M3 or M6.

Procedural outcomes according to risk Sc Low risk (N=63) Moderate risk (N=50) High risk (N=37) p<0.05 vs High risk Failure 1 (1.6%) 1 (2%) 10 (27%) * Recaptures ≥2 4 (6%) 5 (10%) 12 (32%) * Prosthesis ≥2 2 (3%) 1 (2%) 9 (24%) * Inappropriate implantation 0 6 (12%) 7 (19%) * SAES 2 (3%) 6 (12%) 12 (32%) * Pericardial effusion (pericardiocentesis) 2 (3%) 1 (2%) 4 (11%) * Haemorrhage (≥2 points) 0 2 (4%) 5 (13%) * Coronary syndrome 0 0 4 (11%) * Time (intra left atrium) min 21±10 29±16 50±25 * *p<0.05 vs High risk group according to prospective risk score.

LAAC simulation on 3D printed model

Conclusion

3D printing simulation accurately stratifies the risk of procedure according to LA anatomy. 3D printing may guide the procedure through verification of the transseptal puncture site and/or using a specific catheter shape and device. In case of high risk, a careful assessment of risk/benefice ratio is mandatory

Acknowledgement/Funding

AG2RFondation and Boston Scientific
P2458Restricted left atrial motion as a result of atrial stiffening in patients with cardiac amyloidosis
Authors: Higashi H , Inoue K , Saito M , Kinoshita M , Aono J , Ikeda S , Andersen O S , Gude E , Skulstad H , Remme E W , Smiseth O A , Yamaguchi O
Published: October 2019

Background

Left atrial (LA) involvement of abnormal amyloid fibrils could induce LA dysfunction and stiffening in patients with cardiac amyloidosis (CA). Thus, the assessments of LA function and stiffness might be a potential approach to diagnose CA phenotype among patients with hypertrophied hearts.

Purpose

We sought to determine whether LA reservoir strain with speckle tracking echocardiography could be used a marker of LA stiffness in a derivation cohort. Furthermore, we tested to our hypothesis that LA reservoir strain could differentiate CA patients from hypertrophic cardiomyopathy (HCM) in an independent validation cohort.

Methods

In the derivation cohort, echocardiography was performed simultaneously with measurements of pulmonary capillary wedge pressure (PCWP) in 50 patients with suspected or established heart failure and relatively preserved left ventricular (LV) ejection fraction (56±10%). LA maximum and minimum volume index, and reservoir strain were measured from apical four-chamber view. LA stiffness index was computed as a pressure rise from x-trough to v-wave divided by an increase from minimum to maximum indexed LA volume (Figure A). In an independent validation group, we studied a total of 33 biopsy-proved CA patients and 127 HCM patients (LV ejection fraction: 57±11% vs. 66±10%, P<0.01) in sinus rhythm on the date of comprehensive echocardiographic study. Among them, cardiac magnetic resonance imaging (CMR) could be evaluated in 17 CA patients and 98 HCM patients. Furthermore, right heart catheterization was performed with 12 CA patients and 12 HCM patients in the CMR group.

Results

The derivation cohort study found that there was a significant curvilinear correlation of LA reservoir strain to LA stiffness index (Figure B). In the validation cohort, LA reservoir strain was reduced in patients with CA compared with HCM in all participants (11.6±5.6% vs. 18.5±6.9%, P<0.01), although there was no significant difference of LA maximal volume index between 2 groups (37±16 ml/m2 vs. 37±12 ml/m2, p=0.89). In the CMR group, the late gadolinium enhancement was observed in the LA wall in 16 patients with CA (94.1%) as shown in Figure C. In contrast, the LA enhancement revealed only in 1 patient with HCM (1.0%). Among patients with invasive measures, LA stiffness index [median (interquartile range)] was higher in patients with CA than that in patients with HCM [1.1 (0.4–2.8) vs. 0.2 (0.1–0.6), P=0.01].

Conclusions

LA reservoir function was fairly limited in patients with CA compared with HCM. Restricted LA motion might be related to atrial amyloid deposits or fibrosis, which potentially provokes atrial chamber stiffening.
P2467Fusion imaging (Anatomical Intelligence) enables automated left atrial appendage sizing in real-time a single center pilot study
Authors: Afzal S , Veulemans V , Hellhammer K , Piayda K , Nijhof N , Polzin A , Kelm M , Zeus T
Published: October 2019

Background and purpose

Percutaneous left atrial appendage occlusion (LAAO) depicts an alternative treatment for patients with atrial fibrillation who are deemed for long-term oral anticoagulation therapy. In order to perform a successful LAAO accurate sizing of left atrial appendage (ostium, landing zone and depth) for device selection is essential. Echo-Fluoro fusion imaging in real-time offers with its latest prototype a patient-specific segmented automated 3D heart model and sizing of left atrial appendage (LAA). We therefore aimed to evaluate the automated segmented LAA sizing by comparing to 2D transesophageal (TOE) and MSCT measurements as gold standard.

Methods

We studied prospectively data of 8 consecutive patients who were admitted to our clinic for left atrial appendage closure. MSCT was performed preprocedural and analyzed with commercially available 3mensio software (Pie medical imaging). 2D TOE measurements and automated segmentation of the LAA and sizing were performed during the procedure by a highly experienced team of periinterventional cardiac imaging specialist and structural heart disease interventionalist who were blinded to the prior MSCT analysis. Dimension of ostium, landing zone (10 mm into the LAA parallel to the ostial plane at the level of the left circumflex for Amplatzer device) and depth (perpendicular to the ostial plane) were obtained in different TOE views according to instructions for use of Amulet Occluder. In order to generate an automated 3 D heart model, a high-quality 3D TOE image of the LAA volume and surrounding structures was acquired. After successful ECG-gated segmentation a 3 D heart model was generated. Automated LAA sizing followed in real-time. All measurements were taken into consideration before device selection. A Kruskal Wallis test was used to compare mean ranks of independent samples. A concordance analysis according to Kendall W was carried out to investigate reliability.

Results

The mean age of the patients was 82,6±4.15 years and half of the patients were female. All procedures were conducted successfully. The mean values of ostium and landing zone were comparable in TOE, automated sizing and MSCT sizing (ostium: 23,78±2,15 mm vs 25,71±5,25 mm vs 27,35±3,3 mm; (p=0,175); landing zone 22,13±3,18 mm vs 23,57±3,31 mm vs 24,00±3,51 mm; (p=0,377)). Furthermore, a significant concordance between the measurements was shown (ostium W= 0,991; p=0.045, landing zone W=0,835, p=0.014).

Conclusion

Automated LAA sizing acquired by fusion imaging may be an elegant real-time alternative for precise LAA Occluder device selection and needs to be investigated further.
P2470The prognostic importance and inter-relationship of systolic and diastolic tissue Doppler velocities in heart failure patients with reduced ejection fraction
Authors: Sengelov M , Jorgensen P G , Bruun N E , Fritz-Hansen T , Olsen F J , Schou M , Gislason G , Biering-Sorensen T
Published: October 2019

Background

Tissue Doppler imaging (TDI) can be used to evaluate both the systolic and diastolic function in patients with heart failure with reduced ejection fraction (HFrEF). However, previous studies have shown important inter-relationship between these measures in other patient populations.

Purpose

To investigate the prognostic importance and inter-relationship of systolic and diastolic TDI measures in HFrEF.

Methods

Conventional echocardiographic measurements together with peak longitudinal systolic (s'), early diastolic (e'), and late diastolic (a') myocardial velocities from all 6 myocardial walls were obtained from 1065 HFrEF patients. Outcome was all-cause mortality.

Results

Mean age was 67 years, 74% were male and mean left ventricular ejection fraction was 27%. During a median follow-up period of 40 months, 177 (16.6%) patients died.

In univariable analyses, both s' and a' were associated with mortality (p<0.001), but e' was not (p>0.05). Patients were therefore stratified into high/low groups by the mean value of s' and a' respectively. The prognostic value of s' was significantly modified by a' (p for interaction 0.035). In patients with low s', low a' was associated with an increased risk of dying; HR 1.31 (CI: 1.17–1.55, P=0.001) per 1 cm/s decrease.

Patients with both impaired systolic and diastolic function as assessed by low s' and a' had over 3 times greater risk of dying compared to having both high measures of s' and a' (HR 3.39, CI: 2.1–5.1, p<0.001) (figure).

Having combined impaired systolic and diastolic function as assessed by low s' and a' remained an independent predictor of mortality even after multivariable adjustment for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes and conventional echocardiographic measures (HR 1.78 (CI: 1.04–3.04, p=0.035) (table)).

Uni- and multivariable Cox regressions Variable Univariable model (95% CI) Multivariable model* HR (95% CI) P value HR (95% CI) P value High s' and high a' (n=386) Ref Ref High s' and low a' (n=113) 1.48 (1.07–4.03) 0.24 1.36 (0.69–2.70) 0.37 Low s' and high a' (n=156) 2.26 (1.34–3.81) 0.002 1.55 (0.86–2.78) 0.14 Low s' and low a' (n=262) 3.29 (2.43–5.75) <0.001 1.78 (1.04–3.04) 0.035 *Multivariable model adjusted for age, gender, body mass index, mean arterial pressure, ischemic cardiomyopathy, pacemaker, heart rate, total cholesterol, diabetes, left ventricular ejection fraction, left ventricular mass index, and deceleration time.

Kaplan-Meier curves depicting survival

Conclusion

A pattern of combined low systolic and diastolic performance as assessed by s' and a' is a significant marker of adverse prognosis for patients with HFrEF, independent of conventional echocardiographic parameters.

Acknowledgement/Funding

None
P2473Non-invasive assessment of central venous pressure in heart failure: comparing three-dimensional echocardiography and Swan-Ganz catheter
Authors: Szymczyk T , Paluszkiewicz L J , Costard-Jaeckle A , Rudolph V , Gummert J F , Fox H
Published: October 2019

Background

Assessing hemodynamics, in particular central venous pressure (CVP) is essential in heart failure diagnostics, leading individual therapy. Hereby, invasive measurement through Swan-Ganz right heart catheterization (RHC) is considered gold standard for patient evaluation, but catheterization implies risks of invasiveness including bleeding, infection, vessel and nerve injury, as well as patient discomfort. Non-invasive methods are warranted, but no alternative technique is validated yet. Two-dimensional echocardiography (2DE) is believed to be uncertain in this approach as vena cava often shows ellipse-shapes. Therefore, this study sought to investigate standardized and breathing corrected three-dimensional inferior vena cava echocardiography (3DE) to directly compare CVP with right heart catheterization.

Methods and results

We prospectively included 100 consecutive heart failure patients in this study (mean age 53±12 years, body mass index 27±5, New York Heart Association functional class 2.3±0.6, left ventricular ejection fraction 34.1±12.8%, brain natriuretic peptide 658.13±974.03, 76% male), all underwent Swan-Ganz right-heart catheterization and immediately both 2DE and 3DE (Philips EPIQ 7G) of inferior vena cava. From two-dimensional data the diameter of IVC was measured perpendicularly in long and short-axis. From 3DE data a cross-sectional image of IVC was reconstructed for both vertical and horizontal diameters of IVC as well as the area of IVC.

Established 2DE images revealed mean vena cava sizes of 15.9±5.9 mm, while standardized cross-sectional breathing corrected 3DE images showed diameters of 19.8±7.8 mm in longitudinal axis and 15.74±7.8 in short axis. RHC mean CVP was 9.00±5.4 mmHg and correlation of CVP and 2DE measurements failed adequate correlation (2DE 95% CI 0.19–1.61; r=0.25; p=0.312). However, 3DE axis ratio assessment correlated well with invasive CVP and showed reproducible results (3DE 95% CI 0.26–0.69; r=0.89; p<0.01). This resulted for a CVP cut point of 10 mmHg in a 89% true negative and 50% true positive correct detection.

Conclusions

Standardized 3DE correlates well with invasive CVP while established 2DE usual care assessment does not show reliable CVP correlation. 3DE CVP assessment may represent a more feasible and easily applicable method for CVP measurement, including absence for risks of right heart catheterization. Further studies are ongoing to validate these findings in the future.
P2486The association between genetic variant ZNF259 and decreased kidney function in the diabetic patients
Authors: Pereira A , Mendonca M , Monteiro J , Sousa J , Mendonca F , Neto M , Rodrigues R , Sousa A C , Freitas S , Rodrigues M , Freitas A I , Borges S , Ornelas I , Drumond A , Palma Dos Reis R
Published: October 2019

Type 2 Diabetes (T2D) is a risk factor for dysregulation of glomerular filtration rate (GFR) and albuminuria. However, it remains unclear whether this association is only causal. Genetic variants are inherited independent of potential confounding factors and represent a lifetime exposure.

Aim

Investigate whether the reduction of GFR is a direct consequence of T2D or there are other genetic mechanisms involved in the pathophysiology of the evolution to chronic kidney disease.

Methods

Cross-sectional study with a total of 2579 individuals was performed, of which 735 patients had T2D. Subjects were classified as `'diabetic” if they were taking oral anti-diabetic medication or insulin or if their fasting plasma glucose was higher than 7.0 mmol/l or 126 mg/dl. Within the diabetic group, we considered those with (n=63) and without (n=627) decreased GFR. GFR was calculated through the Cockcroft and Gault formula and decreased GFR was defined as GFR<60 ml/min/1.73m2. Twenty-four genetic variants associated with T2D, metabolic syndrome, dyslipidemia and hypertension were investigated for its impact on GFR, namely: MTHFR 677 and 1298; MTHFD1L; PON 55, 192 and 108; ATIR A/C; AGT M235T; ACE I/D; TCF7L2; SLC30A8; MC4R; ADIPOQ; FTO; TAS2R50; HNF4A; IGF2BP2; PPARG; PCSK9; KIF6; ZNF259; LPA; APOE; PSRS1. Risk factors for decreased GFR were also evaluated (essential hypertension, glycaemia >120 mg/ml, dyslipidemia, alcohol consumption, CAD diagnosis). A logistic regression was performed firstly with the risk factors solely; and secondly adding the genetic variants in order to evaluate the independent predictors of progression to renal failure in T2D.

Results

After the first multivariate logistic regression with all the risk factors for decreased GFR, only CAD remained in the equation, showing to be an independent risk factor for progression to renal failure, in T2D (OR=4.17; 95% CI: 1.64–10.59; p=0.003). In the second logistic regression, including risk factors and the genetic variants, only ZNF259 rs964184 showed an independent and significant association with the risk of decreased GFR (OR=3.03; 95% CI: 1.06–8.70; p=0.039).

Conclusion

This study shows that the variant ZNF259 rs964184 is associated with decreased kidney function, independently of other risk factors. This finding needs further investigation to clarify the genetic mechanism behind the association of rs964184 with decreased GFR, in Type 2 diabetes.
P2491Physiologic assessment for coronary artery disease with myocardial perfusion imaging is clinically more relevant when selecting diabetic with high risk features
Authors: Shamoun F , Atwal D A , Tseng A T , Bhatt S B , Girardo M G , Liedl D L , Arsanjani R A , Unzek S U , Wennberg P W
Published: October 2019

Background

Based on previously published data, routine myocardial perfusion imaging in diabetics is not recommended. Selecting patients with diabetes and high risk cardiovascular features could be important to improve the yield of physiologic assessment of the coronary arteries disease and subsequently patient outcome.

Purpose

We posed the question whether nuclear stress testing has a better yield by selecting diabetic individuals with known vascular disease.

Methods

We analyzed records for 15,392 diabetics from 1996 to 2009 with and without vascular disease. Vascular disease is defined as carotid vascular disease, abdominal aortic aneurysm, or peripheral arterial disease. There was 2457 myocardial perfusion studies performed within 2 years of the vascular evaluation. We studied the results of these stress testing in each group and evaluated for the presence of myocardial ischemia. Multivariate Cox proportional regression was used to calculate hazard ratios (HR) with 95% confidence intervals after adjusting for age, gender.

Results

Of those who underwent myocardial perfusion studies 1819 were diabetic with vascular disease group A (mean age 67.8, 70.5% female) and 638 were diabetic without vascular disease group B (mean age 64.5 years, 67.1% female). There was at least one reversible defect suggest myocardial ischemia in 225 and 758 studies in group A and B respectively. Comparing outcome based on the presence of myocardial ischemia in group A without vascular disease, those with vascular disease did have an increased risk of myocardial infarction (adjusted HR: 1.630, 95% CI: 1.281–2.074) and death (adjusted HR: 1.646, 95% CI: 1.413–1.918).

Conclusion

Myocardial perfusion imaging is a reasonable test in patients with diabetes and vascular disease. The presence of myocardial ischemia is more common and is associated with worse cardiovascular outcome.

Acknowledgement/Funding

None
P2501Validation of FRIEND and ACSM equations for cardiorespiratory fitness: comparison to direct measurement in male CAD patients
Authors: Jang W Y , Kang D O , Park Y , Kim W , Park E J , Na J O , Choi C U , Rha S W , Park C G , Seo H S , Kim E J
Published: October 2019

Introduction

Cardiorespiratory fitness (CRF) is associated with a high risk of cardiovascular disease and all-cause mortality. The regression equation of American College of Sports Medicine (ACSM) was a preferred method for estimating maximal oxygen consumption (VO2max). It is well-known that CRF is overestimated in ACSM equation. Recently, Kokkinos reported more precise equation from the Fitness Registry and the Importance of Exercise National Database (FRIEND). Both equations were made from western healthy people.

Purpose

In this study, we compared VO2max estimated by ACSM and FRIEND equations to VO2max directly measured in male coronary artery disease (CAD) patients.

Methods

We analyzed 103 male CAD patients who underwent percutaneous coronary intervention and who participated in cardiac rehabilitation between June 2015 and December 2018. VO2max was directly measured by the gas exchange analysis during treadmill test with modified Bruce protocol. Exclusive criteria were pulmonary disease, chronic kidney disease on hemodialysis, malignancy, peripheral artery disease, insufficient cardiopulmonary exercise test and orthopedic injuries. Directly measured VO2max were compared to ACSM and FRIEND equations.

Results

Age-specific VO2max values, which were directly measured from male CAD patients, were shown in Table. Smaller CRF difference was shown in FRIEND equation than ACSM equation. Compared to the measured value, CRF estimated by ACSM equation was overestimated by 22%, but the one estimated by FRIEND equation had only 2% gap. Figure presents Bland-Altman plots. ACSM equation had the higher bias (5.52ml/kg/min) compared with FRIEND equation (0.200ml/kg/min).

Comparison table of VO2max estimated by ACSM and FRIEND equations with directly measured VO2max in male CAD patients Age Number VO2max (ml/kg/min) Measured ACSM % predicted FRIEND % predicted 30–39 4 29.5 ± (6.6) 35.7 ± (6.1) 122.3 ± (8.5) 29.1 ± (4.3) 100.1 ± (8.7) 40–49 20 29.1 ± (5.1) 35.7 ± (5.4) 123.6 ± (11.1) 29.1 ± (3.8) 101.2 ± (9.5) 50–59 32 25.6 ± (4.3) 31.5 ± (5.1) 123.8 ± (10.1) 26.2 ± (3.6) 103.2 ± (8.5) 60–69 27 26.0 ± (5.1) 31.1 ± (2.6) 120.5 ± (12.6) 25.9 ± (4.0) 100.8 ± (10.5) 70–79 18 21.2 ± (6.0) 26.8 ± (5.4) 123.2 ± (14.8) 22.8 ± (3.9) 105.2 ± (12.0) >80 2 25.0 ± (10.1) 22.8 ± (2.6) 97 ± (28.9) 19.9 ± (1.9) 85.1 ± (27.0) Total 103 25.7 ± (5.6) 31.4 ± (6.0) 122.2 ± (12.4) 26.1 ± (4.3) 102.1 ± (10.4) Data are presented as mean ± (standard deviation).

Bland-Altman plots

Conclusions

FRIEND equation can estimate CRF more accurately than ACSM equation, even in Asian patients with CAD.
P2505Cardiorespiratory fitness in childhood is an independent predictor of subclinical cardiovascular disease in adulthood: The Childhood Determinants of Adult Health Study
Authors: Huynh Q , Venn A J , Magnussen C , Marwick T H
Published: October 2019

Background

Asymptomatic myocardial disease is the precursor to heart failure – to which cardiorespiratory fitness (CRF) is an important contributor. It is however unclear if CRF in childhood can predict cardiovascular disease in adulthood and whether it can do so independently of adult risk factors.

Methods

This study followed 562 participants from childhood (aged 7–15 years in 1985) to adulthood (aged 36–49 years in 2017–19). Time to finish a 1.6km run was standardised by age and sex to estimate CRF in childhood. CRF in adulthood was estimated using physical working capacity at a heart rate of 170bpm. Echocardiogram was used to identify abnormal myocardial function and structure in adulthood, including reduced global longitudinal strain (abnormal GLS greater than −18% in 102/562 participants), left ventricular hypertrophy (LVH in 55/562), dilated left atrial (LA volume index>34 in 268/562) and increased LV filling pressure (E/e'>8 in 32/562).

Results

CRF tracks weakly through the life-course (r=0.14, p<0.001). Childhood CRF was negatively associated with abnormal GLS (OR=0.76 [95% CI: 0.62, 0.92]), and was positively associated with dilated LA (OR=1.33 [95% CI: 1.12, 1.59]) and LV hypertrophy (OR=1.39 [95% CI: 1.01, 1.92]) in adulthood. There was no association with increased LV filling pressure. While the associations with abnormal GLS and dilated LA were independent of adult CRF, the association of LV hypertrophy was attenuated and rendered insignificant after adjusting for adult CRF. A simple predictive model including age, sex and childhood CRF could predict abnormal GLS in adulthood with good discrimination (C-statistic=0.71 [95% CI: 0.66, 0.77]) – which was not significantly different from a predictive model using adult risk factors (p=0.53).

Conclusions

CRF in childhood is an important and independent predictor of subclinical cardiovascular disease in adulthood.
P2517Feasibility and safety of cardiac rehabilitation program during Ramadan fasting among patients having coronary artery disease and moderate left ventricular dysfunction
Authors: A Rifaie O , Shabana A M , Alaa Y A , Khorshed H M
Published: October 2019

Background

Ramadan fasting (RF) is an important worship activity for Muslims. It entails complete abstinence of food and fluids from dawn to sunset (14–16 hours) for 30 days. The safety and feasibility cardiac rehabilitation program during (RF) is largely unknown.

Aim

To assess safety and feasibility of cardiac rehabilitation program (CRP) during (RF) in patients with coronary artery disease (CAD) with moderate left ventricular dysfunction (LVD). Moreover, to study the effect of (RF) on some blood parameters

Patients and methods

Fifty three patients joining (CRP) at our university hospital were included in the study. All had (CAD) with moderate (LVD). Patients were divided into two groups according to their Ramadan fasting status. Group I (fasting) were 32, while group II (non fasting) were 21. All patients underwent exercise training during cardiac rehabilitation in Ramadan. Serum lipid profile, plasma osmolality, renal functions, echocardiography and exercise parameters were assessed before and after (CRP).Clinical follow up was available for one month post Ramadan.

Results

The two groups were similar in baseline characteristics including: risk factors, serum osmolality, urea, creatinine, lipid profile, hemoglobin values, ejection fraction and exercise parameters.All patients successfully completed the (CRP). No patient in group I had any ischemic episode or exacerbation of (LVD) during or one month after the end of Ramadan.After the program, both groups showed significant improvement in ejection fraction (group I: 43±2% to 52±2%, p<0.001, group II: 41.1±4 to 47.2±3%. p<0.002), total cholesterol (group I: 174.8±40.8 to 169.4±37.1 mg%, p=0.034, group II: 172.9±43.3 to 163.0±40.7 mg%, p=0.01), LDL: Group I: 100.7±33.4 to 94.5±261 mg%, p=0.023, group II: 104.5±42.1 to 93.8±33.8 mg%, p=0.005), and HDL: Group I: 42.7±10.6 to 44.5±10.9 mg%, p=0.029, group II: 40.6±8 to 45±8.9 mg%, p<0.001). However, triglyceride levels improved significantly only in group I (162.3±65.4 to 152.8±52.3 mg%, p=0.042, group II: 144±60 to 133.9±48.8 mg%, p=0.149) l. There was also similar improvement in exercise duration after (CRP) in both groups. It is worthy to note that fasting did not increase the serum osmolality in group I (277.91±15.14 before, and 281.01±11.61 mmol/L after (RF), p value= 0.34)

Conclusion

Cardiac rehabilitation is feasible and safe among patients with (CAD) and (LVD) during (RF). Moreover, (RF) resulted in significant improvement in serum triglycerides without change in plasma osmolality denoting absence of hemoconcentration despite fasting.
P2521Exercise-Based Cardiac Rehabilitation in post myocardial infarction patients with mid-range ejection fraction
Authors: Burazor I , Seferovic P , Ostojic M , Ivanovic B , Andjic M , Otasevic P , Constantinos D , Adler Y
Published: October 2019

Heart failure is a major cause of morbidity, mortality and re-hospitalizations and is highly prevalent in myocardial infarction survivors. Cardiac rehabilitation based on exercise training and heart failure self-care counseling have each been shown to improve clinical status and clinical outcomes. We designed our study with aim to evaluate the usefulness of exercise based in house cardiac rehabilitation/ secondary prevention program in patients with heart failure with mid-range ejection fraction (HFmrEF) after myocardial infarction.

Patients and methods

Out of 2753 patients who were admitted to our three weeks in- hospital secondary prevention program – exercised based cardiac rehabilitation, we analyze a total of 219 patients who were admitted early after coronary revascularization (percutaneus coronary interventions or coronary bypass surgery) with HFmrEF. The majority of patients were males (68%). Risk factors and co morbidities were noted. Patients were selected for exercise training after six minute walking test or exercise stress test (cardiopulmonary dominantly to evaluate unexpected exertional dyspnea). After 3 weeks in house cardiac rehabilitation the patients were re-tested.

Results

The major comorbidities in our patient population were as follows: hypertension, diabetes and dyslipidemia. Six minutes walking test was performed and the total distance walked ranged from 120 to 480 meters and the beginning of the program. Patient had 7 -days a week training program. After the 3 weeks in hospital exercise rehabilitation the improvement in the test was ∼32%. Cardiopulmonary test showed also improvement of functional capacity.We noted several rhythm disturbance complications by telemetry (VES, SVES). None had acutisation of heart failure (with peripheral edema and congestion). All patients fulfilled cardiac rehabilitation program.

Conclusions

Supervised multidisciplinary cardiac rehabilitation program, including an individualized exercise component is effective and can improve functional status and exercise tolerance in patient with HFmrEF after myocardial infarction.
P2535Pregnant patients with pulmonary hypertension-the case of a medical centre
Authors: Irtyuga O , Sefieva J , Karelkina E , Gabrelyan A , Bautin A , Yakubov A , Li O , Pervunina T , Zazerskaya I , Moiseeva O
Published: October 2019

Background

Nowadays, Pulmonary Hypertension (PH) is one of the most pressing issues in cardiovascular disease. Subsequently, pregnant women have a high degree of risk of morbidity and mortality and this poses a big challenge. Studies show that very often PH occurs due to congenital heart disease and for this reason, it is recommended to avoid pregnancy or to terminate the pregnancy at an early stage. Women who choose to remain pregnant should be treated at specialized PH centers with the experience of managing PH during and after pregnancy.

Purpose

The main purpose of this study was to estimate the survival of pregnant pts with PH depending on the severity of PH and etiology.

Methods

8336 women during delivery on admission were screened from the period spanning January 2014 to December 2016. Of this number, 4268 (51%) the medical records of pregnant women with cardiovascular disease were retrospectively reviewed to identify patients with coexisting PH and pregnancies. Data on 98 (1.18%) pts with PH were identified and included in the study. All patients' PH severity was measured by Doppler echocardiography. Pulmonary artery systolic pressure value of 35 to 50 mm Hg, 51 to 70 mm Hg, or greater than 71 mm Hg measured by echocardiography corresponded to the mild, moderate, or severe PH, respectively. Demographics, characteristics of PH and pregnancy, management and outcomes were as well analyzed.

Results

54 cases (55%) were classified into WHO group 1, 40 cases (41%) in group 2 (reason –left heart disease), 4 cases (4%) in group 4 (reason - pulmonary thromboembolism), and none in group 3 or 5. The systolic pulmonary artery pressure was <50 mmHg in 70,4% of patients, 51–70 mmHg in 18,4% and ≥70 mmHg in 11,2% The median age was 28 years. All deaths occurred in women with PH in WHO group 1, with moderate or severe PH severity, and with NYHA grade of III to IV. Pulmonary vascular-targeted medications were used in all pts with severe PH and in some cases with moderate PH 14 pts (14%), but none was administered to pts with mild PH. During pregnancy, 9 pts took monotherapy of the sildenafil but 1 pregnant patient took a combination of therapy with iloprost. After delivery, 14 pts took monotherapy and 9 took combination therapy. This notwithstanding, 3 pts who took the combination therapy (3%), died within 15 days after delivery (9,14,15 days, respectively). All of them died from uncontrolled PH and heart failure after delivery.

Conclusion

Our study shows that maternal mortality is associated with the severity of PH. Mortality in pregnant patients with pulmonary hypertension is still the most discussed problem in cardiology and obstetrics. It is necessary to diagnose this disease at an early stage, prevent pregnancy in pts with severe to moderate PH as much as possible, continue observation, adequately apply therapy in order to help curtail this problem.
P2540Sex-specific differences in the clinical presentation, surgical complications, and course of chronic thromboembolic pulmonary hypertension
Authors: Barco S , Klok F A , Konstantinides S V , Dartevelle P , Fadel E , Jenkins D , Kim N H , Madani M , Matsubara M , Mayer E , Pepke-Zaba J , Simonneau G , Delcroix M , Lang I M
Published: October 2019

Background

Women are more susceptible to develop several forms of pulmonary hypertension, but they may have better survival rates than men. Sparse data are available concerning sex-specific differences in chronic thromboembolic pulmonary hypertension (CTEPH).

Purpose and methods

We investigated sex-specific differences in the clinical presentation of CTEPH, functional parameters, exposure to pulmonary endarterectomy (PEA), and survival.

Results

Women constituted half of the study population (N=679 treatment-naïve patients from the European CTEPH registry) and were characterized by a lower prevalence of some cardiovascular risk factors (e.g. prior acute coronary syndrome, smoking habit, chronic obstructive pulmonary disease), but more prevalent obesity, cancer, and thyroid diseases. Median age was 62 (IQR 50–73) years in women and 63 (IQR 53–70) in men. Women underwent PEA less often than men (54% vs 65%; Figure 1, Panel A) and were exposed to fewer additional cardiac procedures, notably coronary artery bypass graft surgery (0.5% vs. 9.5%). The prevalence of specific reasons for not being operated, including the patient's refusal and the proportion of proximal vs. distal lesions, did not differ between sexes. A total of 57 (17.0%) deaths in women and 70 (20.7%) in men were recorded over long-term follow-up. Female sex was positively associated with long-term survival (adjusted Hazard Ratio 0.66; 95% Confidence Interval 0.46–0.94). Short-term mortality was identical in the two groups (Figure 1, Panel B).

Conclusions

Women with CTEPH had a lower prevalence of cardiovascular risk factors and underwent PEA less frequently than men, who, in turn, were more often exposed to additional major cardiac surgery procedures. Women had more favorable long-term survival.

Acknowledgement/Funding

The CTEPH registry is supported by a research grant from Actelion Pharmaceuticals Ltd.
P2547Statin and glucose-lowering treatment in individuals with and without schizophrenia
Authors: Eriksson S V E N , Eberhard J , Osby U , Westman J , Forslund L , Wallen J
Published: October 2019

Background

We have recently shown that Cardiovascular (CV) mortality is surprisingly high in patients with schizophrenia in Sweden. Diabetes is 2–3 times more common in patients with schizophrenia. Treatment with Metformin have consistently shown effective to lower CV mortality in patients with diabetes. In addition, recent studies have shown that treatment with Metformin reduces weight and improves lipids even in patients with schizophrenia without diabetes. One reason for the high CV mortality in Swedish patients with schizophrenia may be lack of risk factor treatment, such as glucose-lowering treatment and/or lipid lowering treatment with statins.

Objective

To determine the prevalence of treatment with glucose-lowering treatment and statins in patients with and without schizophrenia in Stockholm, Sweden.

Material and methods

Cross-sectional study based on individual-level patient data from the Stockholm regional health-care data warehouse. 6 347 patients with a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision code F 20.X) were compared with 2 062 112 without schizophrenia from Stockholm County. The prescription of Metformin and insulin were compared in 5-year age groups from 30 to 85 years of age. In addition, the prescription of statins (any statin) were also compared in the same population.

Results

The prescription of metformin in age groups under 60 years were approximately 2 to 8 times more common in patients with schizophrenia, in patients over 60 the corresponding figures were 0.7 to 3 times. The prescription of statin in age groups under 60 were approximately 0.8–3 times more common in patients with schizophrenia. In contrast, in patients over 60 years statins were less often prescribed in patients with schizophrenia compared to controls.

Figure 1

Conclusions

Our results indicate that lack of treatment with metformin may not be a reason for the increase cardiovascular mortality in patients with schizophrenia. However, the surprisingly low prescription of statins in older (>60 years) patients with schizophrenia might explain the high CV mortality in this patient group.
P2548Lithium use and risk of out-of-hospital cardiac arrest in patients with bipolar disorder: A nationwide nested case-control study
Authors: Christensen D M , Barcella C A , Gerds T A , Gislason G H , Torp-Pedersen C , Kessing L V , Mohr G H
Published: October 2019

Background

Lithium is a mood stabilizer widely used in the treatment of bipolar disorder. Lithium has been linked to malignant proarrhythmic electrocardiographic changes such as QT-prolongation, atrioventricular and sinoatrial block. However, evidence regarding the risk of cardiac arrest with lithium use is lacking.

Purpose

We investigated the risk of out-of-hospital cardiac arrest associated with lithium use among patients with bipolar disorder.

Methods

All out-of-hospital cardiac arrest cases from 2001 through 2014 of presumed cardiac cause with a history of bipolar disorder were identified from the nationwide Danish Cardiac Arrest Registry. We conducted a nested case-control study by matching all cardiac arrest cases with bipolar disorder on age, sex and time since first diagnosis of bipolar disorder with four controls from the general population who also had a history of bipolar disorder. Conditional logistic regression adjusted for comorbidities and concomitant pharmacotherapy was used to determine the association between lithium monotherapy and risk of out-of-hospital cardiac arrest compared to mood stabilizing monotherapy with valproate, lamotrigine and quetiapine, respectively. Exposure was defined as redeemed prescriptions for only one of either lithium, valproate, lamotrigine or quetiapine up to two months before index.

Results

The study population consisted of 1,410 patients with bipolar disorder, comprising 282 out-of-hospital cardiac arrest cases each matched with 4 controls. The median age was 69 years, 47.2% were male and the median time from first diagnosis of bipolar disorder was 7.25 years. Among cases, 59 (20.9%) were in lithium monotherapy and among controls the number was 299 (26.5%). For monotherapy with other mood stabilizers we observed the following distributions: quetiapine 18 (6.4%) cases and 51 (4.5%) controls, valproate 12 (4.3%) cases and 51 (4.5%) controls, and lamotrigine 15 (5.3%) cases and 64 (5.7%) controls. Lithium was not associated with an increased risk of OHCA compared to other mood stabilizing drugs: Hazard ratio (HR) 0.64 [95% confidence interval (CI) 0.31–1.33] (reference quetiapine), HR 0.56 [95% CI 0.25–1.24] (reference valproate) and HR 0.53 [95% CI 0.25–1.10] (reference lamotrigine).

Figure 1

Conclusion

Among patients with bipolar disorder, lithium was not associated with an increased risk of cardiac arrest compared to other mood stabilizing drugs. Further studies focusing on the cardiovascular safety of mood stabilizing drugs are warranted.
P2549The cardiovascular predictors of clinical outcomes in patients after ischemic stroke of undetermined etiology
Authors: Bielecka-Dabrowa A , Gasiorek P , Sakowicz A , Banach M
Published: October 2019

Purpose

The study aimed to identify echocardiographic, hemodynamic and biochemical predictors of unfavourable prognosis after ischemic strokes of undetermined etiology (ESUS) in patients (pts) at age <65.

Methods

Out of 520 ischemic stroke pts we selected 64 pts diagnosed with ESUS [mean age 54 (SD: 47–58) years, 42% males] and additional 36 without stroke but with similar risk profile, which were treated as a reference group [age 53 (SD: 47–58) years, 61% males]. All pts underwent echocardiography, non-invasive assessment of hemodynamic parameters using SphygmoCor tonometer (Atcor Med., Australia), HDL subfraction distribution using Lipoprint (Quantimetrix) as well as measurements of selected biomarkers. Follow-up was 12 months.

Results

At 12-month follow-up 9% of patients had died, and recurrent ischemic stroke also occurred in 9% of patients - only in the ESUS group (Figure). Patients who died had significantly lower levels of LDL and HDL cholesterol (included HDL-8 and -9 subfractions) and higher level of triglicerides (p=0.01, p=0.01, and p=0.02; respectively), lower level of adiponectin (p=0.01), lower value of mean early diastolic (E') mitral annular velocity (p=0.04) and lower diastolic blood pressure (p=0.04). The atrial fibrillation (AF) occurred in 10% of pts during the 12 months (log-rang, p=0.254) (Figure). The log-rank test showed that ESUS group had a significantly poorer outcome of AF in the first 2 months after hospitalization compared to reference group (11% vs 5%, p=0.041). Based on a Kaplan-Meier analysis, the outcome of re-hospitalizationin the 1st year was 28% (18/64) in the ESUS group and 17% (6/36); log-rank, p=0.058. In the multivariate analysis mean early diastolic (E') mitral annular velocity (odds ratio [OR] 0.75, 95% confidence interval [CI]: 0.6–0.94; p=0.01) was significantly associated with CV hospitalizations assessed at 12-month follow-up. The only independent predictor of AF occurrence in the 12-month follow-up was lower value of Tissue Doppler-derived right ventricular systolic excursion velocity S' (OR 0.65, 95% Cl 0.45–0.93; p=0.01). The only independent predictor of recurrent stroke was the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic mitral annular motion as determined by pulsed wave Doppler (E/E') (OR 0.75, 95% CI: 0.6–0.94; p=0.01). E/E' ratio was also independently associated with composite endpoint consisting of death, hospitalization and recurrent stroke (OR 1.90, 95% CI 1.1–3.2, p=0.01).

Kaplan-Meier Analysis - survival and AF

Conclusions

The indices of diastolic dysfunction are significantly associated with unfavourable prognosis after ESUS. There is a robust role for outpatient cardiac monitoring especially during first 2 months after ESUS to detect potential AF.

Acknowledgement/Funding

The study was financed by research grants no. 502-03/5-139-02/502-54-229-18 of the Medical University of Lodz