bluuebunny/crossref_metadata_2025 huggingface dataset:
P769Quality of life in outpatients with heart failure in relation to mortality and admissions for heart failure
Authors: Grundtvig M , Vollnes-Eriksen T , Hole T
Published: October 2019

Studies report relation between quality of life and outcome. However, less is known about how various aspects of quality of life relates to mortality and admissions for heart failure.

Method

Mortality was examined in 7001 patients with completed Minnesota Living with Heart Failure Questionnaire (MLWHFQ) at the first visit to specialised hospital outpatient clinics included in our registry. A subset of 4264 patients with a second MLWHFQ at a late follow-up visit was assessed for the number of admissions and days in hospital for reason of heart failure during a six months period prior to the late visit.

Results

In multivariate Cox proportional hazard regression model for time to death after the first visit with a median 19 months follow-up and 1001 deaths, the MLWHFQ score for the subset of the “physical domain” (question 2 to 9) was a significant independent predictor for mortality (P=0.002) adjusted for gender, NYHA-class, blood pressure, s-sodium, stroke, obstructive lung disease, eGFR, anemia, age, daily dose diuretic, and ischemic cause for heart failure. The total MLWHFQ score and the Minnesota “emotional domain” (question 17–21) were not significant variables when the MLWHFQ “physical domain” was entered in the analysis.

The number of admissions for heart failure and the number of days in hospital for these admissions in a six months period prior to the late visit were analysed by linear regression for related variables. The total MLWHFQ score at the late visit was highly significant for the number of admissions in the six months period (p<0.001) adjusted for the daily dose diuretic, NYHA functional class and proBNP. The MLWHFQ “physical domain” and the MLWHFQ “emotional domain” were not significant variables when the total score was entered. The number of days in hospital was related to the daily dose diuretic, NYHA functional class, proBNP, and in addition anaemia at the late visit again with the MLWHFQ total score being a significant predictor (=0.001)

Conclusions

Disease specific quality of life measured with MLWHFQ “physical domain” was a highly significant predictor for mortality after the first visit. The late total MLWHFQ score was a better predictor for heart failure related admissions and days in hospital than the subset domains in multivariate analysis.

Acknowledgement/Funding

None
P770New disease-specific adherence questionnaire can predict 2-year survival in chronic heart failure
Authors: Voronkov L G , Solonovych A S
Published: October 2019

Background

Several studies demonstrated that adherence to treatment is a predictor of clinical prognosis in cardiovascular patients (pts). It may be assumed that disease-specific questionnaires may better separate pts by their clinical risk than non-specific ones.

Objective

To compare the prognostic value of conventional Morisky-Green non-specific adherence questionnaire (MGQ) and proposed new disease-specific questionnaire in chronic heart failure (CHF).

Methods

124 stable CHF pts NYHA II-III with reduced left ventricular ejection fraction (rLVEF) on standard treatment were examined. To evaluate pts adherence to treatment we used MGQ and proposed by our HF clinic new score which include 10 questions: 1) Can you name cardiologic medications which have been taken by you during last month? (yes – 1 point, no – 0); 2) Have you taken regular all cardiologic drugs recommended for you during last month? (yes – 1, no - 0); 3) Did you sometimes miss your medications intake during last month? (yes – 0, no – 1); 4) Did you withdraw recommended cardiologic drugs by yourself when your feeling is good? (yes – 0, no – 1); 5) Do you know you should take recommended drugs all time? (yes – 1, no – 0); 6) Is the time of all your drugs intake written down by you? (yes – 1, no – 0); 7) Are there any days when you forget to take your medicines? (yes – 0, no – 1); 8) I assess my weight not less than 3 times a week (yes – 1, no – 0); 9) I monitor my fluid intake regularly (yes – 1, no – 0); 10) I keep low-salt diet (yes – 1, no – 0). Adherence if 8–10 point – good, 5–7 – moderate, ≤4 – poor.

Results

By the final score of each questionnaire, pts were divided for 2 groups: 1) with poor-to-moderate adherence (for MGQ ≤3; for new questionnaire ≤7) and 2) with good adherence (for MGQ 4; for new questionnaire 8–10). MGQ failed to predict long-term (24 month) survival (fig. 1) while poor-to-moderate adherence detected by new score was associated with significantly lower survival rate (fig. 2).

Survival curves

Conclusion

In contrast to non-specific MGQ, proposed disease-specific questionnaire is valid to predict 2-year survival in CHF with rLVEF. More data are needed to introduce it in practice.
P772Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers for heart failure patients with different left ventricular ejection fraction categories: from the KCHF Registry
Authors: Yoshikawa Y , Tamaki Y , Yaku H , Yamamoto E , Ozasa N , Inuzuka Y , Morimoto T , Kato T , Kimura T
Published: October 2019

Background

The current guidelines recommend different medical treatment strategies for heart failure (HF) patients according to category of left ventricular ejection fraction (LVEF). Angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACE-I/ARB) is an established medical treatment for heart failure with reduced ejection fraction (HFrEF), whereas its usefulness remains to be elucidated for non-HFrEF, especially for heart failure with mid-range ejection fraction (HFmrEF).

Purpose

This study aimed to assess the difference in association between ACE-I/ARB and clinical outcomes depending on LVEF category.

Methods

The Kyoto Congestive Heart Failure (KCHF) Registry is a multicentre registry without any exclusion criteria which included consecutive patients hospitalized for congestive HF in Japan. In each LVEF group (HFrEF, HFmrEF and heart failure with preserved ejection fraction [HFpEF]), we compared those who were prescribed ACE-I/ARB as discharge medication and those not, and assessed their 1-year clinical outcomes. We defined the primary outcome measure as a composite of all-cause death and HF hospitalization. We constructed a multivariable Cox regression model incorporating 24 clinically relevant factors. We assessed adjusted hazard ratios (HRs) of those with ACE-I/ARB relative to those not, and also interaction between ACE-I/ARB prescription at discharge and LVEF category.

Results

A total of 3717 patients were included in this study, where the number of patients in each LVEF group were as follows; 1383 patients with HFrEF, 703 with HFmrEF and 1631 with HFpEF, respectively (Figure). As shown in the table, the HRs for the primary outcome measure were significant in the HFrEF and HFmrEF groups, whereas the HR in the HFpEF group was insignificant. The interaction between ACE-I/ARB prescription and LVEF category for the primary outcome measure was statistically significant.

Hazard ratios by LVEF category Outcome measures HFrEF HFmrEF HFpEF P interaction HR (95% CI) P value HR (95% CI) P value HR (95% CI) P value All-cause death + HF hospitalization 0.66 (0.54–0.79) <0.001 0.61 (0.45–0.82) 0.001 0.95 (0.80–1.14) 0.61 0.01 All-cause death 0.62 (0.48–0.81) <0.001 0.52 (0.35–0.77) 0.001 0.73 (0.58–0.93) 0.01 0.10 HF hospitalization 0.73 (0.57–0.92) 0.009 0.59 (0.40–0.87) 0.007 1.14 (0.90–1.44) 0.28 0.07 Hazard ratios of ACE-I/ARB relative to non-ACE-I/ARB for primary outcome measures in each LVEF category.

Study flowchart

Conclusions

The risk ratios of those who were prescribed ACE-I/ARB relative to those not were significantly low in HFmrEF as well as HFrEF, whereas the risk ratios were insignificant in HFpEF. ACE-I/ARB could be a potential choice of treatment for HFmrEF patients.
P779Eligible patients for the PARADIGM-HF trial in a real-world outpatient clinic and its cardiovascular risk
Authors: Chen X , Schaufelberger M , Fu M
Published: October 2019

Background

In the PARADIGM-HF trial sacubitril-valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), was more effective than enalapril for some patients with heart failure (HF). However, the eligibility of the PARADIGM-HF study to a real-world heart failure population was not well established.

Purpose

To investigate the eligibility of PARADIGM-HF Trial in a real-world clinical setting and its cardiovascular risk.

Methods

We made secondary analysis of patients (n=4872) with heart failure prospectively enrolled in the Swedish Heart Failure Registry from the Outpatient Clinic, during 2005–2016. The eligibility for PARADIGM-HF in real world was studied based on patients whether they were either fully or partially compatible with the PARADIGM-HF study population. Mortality data during follow-up were obtained from the Death Registry of the National Board of Health and Welfare in Sweden.

Results

Heart failure with reduced LVEF (≤40%) (HFrEF) were found in 2165 patients, 653 patients (30%) were fully and 958 (44%) were partially compatible with PARADIGM-HF criteria respectively (figure). In both the fully and partially eligible groups there were more male. Despite that the fully eligible patients were younger than non-eligible patients (77.6±12.7 vs. 84.0±13.7 years), they were clearly older than in PARADIGM-HF trial. Moreover, those fully-eligible patients had lower all-cause mortality compared with both partially-and non-eligible patients (45.6% vs. 68.5, HR 1.43 (1.18–1.75) p<0.001) after adjusted for sex, age, BMI, smoking, hypertension and diabetes. However, both fully- and partially eligible patients had higher all-cause mortality than that in PARADIGM-HF.

figure

Conclusion

In a real world outpatient clinical setting, around 35% to 50% of HFrEF were eligible for treatment with ARNI except that they are older, sicker and carried higher risk for all-cause mortality than the PARADIGM-HF trial population.
P782The evaluation of a nurse-led Sacubitril/Valsartan initiation and titration clinic
Authors: Brown A , Westley K , Amiruddin Z , Driver W , Runnett C , Matthews I , Ripley D , Thomas H
Published: October 2019

Background

Sacubitril/Valsartan is a new NICE-approved treatment for heart failure patients with NYHA 2–4 symptoms, LVEF<35% and on a stable dose of ACEi/ARB medication. The PARADIGM-HF trial was stopped early after showing an absolute risk reduction of cardiovascular death/hospitalisation of 5%. NICE specify that it should be initiated by a heart failure specialist with access to a multidisciplinary team. We set up a secondary care specialist nurse-led clinic in our trust in North England for Sacubitril/Valsartan initiation and monitoring.

Purpose

To assess compliance to NICE guidelines and establish the number of clinic visits required for dose titration. To compare demographics and treatment outcomes of our patients with the trial population.

Methods

A retrospective analysis of all patients prescribed Sacubitril/Valsartan over two years with a minimum follow up of 6 months. Data was collected from patient records and compared with NICE guidelines and the PARADIGM-HF trial (total population and Western European subset).

Results

159 patients commenced Sacubitril/Valsartan. Table 1 shows demographic and therapy data and demonstrates our cohort is largely similar to the Western Europe cohort of Paradigm-HF. However, our patients had higher rates of MRA and complex device treatments. Prescribing was compliant with NICE guidelines in 97%. Failure to exceed the target 50% ACEi/ARB dose was the main reason for non-compliance in 60% (3/5). These 3 patients all discontinued. Overall 16% discontinued the drug (42% for hypotension) compared to 18% in the trial. No serious adverse reactions occurred. Mean number of clinic visits was 3.7±1.4.

Table 1. Demographic and therapy data Cohort size Age Female % Ischaemic Aetiology % LVEF B-Blocker % MRA % CRT % ICD % North England 159 69.3±11.1 20 59 27 90 73 23 47 PARADIGM-HF full trial 8442 63.8±11.5 21 60 30 93 54 7 15 Western European Subset 1680 68.3±9.9 18 30 95 44 12 33

Conclusion

Our cohort closely reflects the trial and the resultant NICE guidelines. More of our patients are treated with MRA and complex devices compared to PARADIGM-HF. This may be due to the quality of our service or may reflect our patient selection. Similar tolerability in our patients is reassuring as study patients are highly selected. Those receiving suboptimal ACE/ARB doses (therefore not NICE compliant) prior to initiation all failed to tolerate the new drug which cautions against straying from guidance. Our data shows a specialist nurse-led service can be delivered safely and effectively achieving therapeutic doses with a small number of patient visits. This data supports its deliverability in a non-trial setting.
P783Guideline-directed therapy at discharge is important in patients with heart failure and atrial fibrillation
Authors: Yoo B S , Ahn M S , Lee S J , Son J W , Kim J Y , Park S W
Published: October 2019

Background

There are limited and conflicting data regarding the prognostic implication of guideline-directed therapy, especially in heart failure (HF) patients with atrial fibrillation (AF). Thus, this study evaluated the relationship between guideline adherence to recommended therapy at discharge and relevant 60-day clinical outcomes in acute HF patients with AF having reduced ejection fraction (HFrEF) or preserved ejection fraction (HFpEF).

Methods and results

Of 5,625 acute HF patients in the Korean Acute Heart Failure Registry, 2,071 with documented AF (HFrEF, n=986; HFpEF, n=1,085) were separately analysed. A guideline adherence score was calculated for the prescription of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, β-blockers, mineralocorticoid receptor antagonists, and anticoagulants. In HFrEF patients with AF, there was significant trend of increase in mortality (p for trend <0.001) and composite endpoint (p for trend = 0.002) according to guideline adherence. Poor adherence was associated with a significantly high risk of mortality (hazard ratio [HR], 4.75; 95% confidence interval [95% CI], 1.77–12.74) and composite endpoint (HR, 2.36; 95% CI, 1.33–4.18). In HFpEF patients with AF, there was a significant increasing trend for rehospitalization (p for trend = 0.04) and composite endpoint (p for trend = 0.03). However, the beneficial effect of good guideline adherence was statistically non-significant for all clinical outcomes

Conclusion

Better adherence to guidelines was associated with a better 60-day prognosis in both HFrEF and HFpEF patients with AF. However, the beneficial effect of guideline adherence was more pronounced in HFrEF patients with AF.
P789TLR-4 expression predicts mortality in patients with acute heart failure
Authors: Krychtiuk K A , Lenz M , Huber K , Hengstenberg C , Wojta J , Heinz G , Speidl W S
Published: October 2019

Background

Inflammation is regarded as an important trigger for disease progression in heart failure (HF) and activation of the inflammatory system was implicated in the pathophysiology of acute heart failure (AHF).

Toll-like receptors (TLRs) play an important role in acute inflammatory processes in critically ill patients by binding to pathogen associated molecular patterns (PAMP) and danger associated molecular patterns (DAMP). However, it is not known whether the expression patterns of TLRs on neutrophils and monocytes are associated with outcome in patients with severe AHF requiring intensive care unit (ICU) admission.

The aim of this prospective, observational study was to analyze whether TLR-expression on monocytes or neutrophils is associated with 30-day survival in patients with severe AHF.

Methods

We included 84 patients with severe AHF admitted to a cardiac ICU. Blood was taken at admission and mean fluorescence activity (MFI) of TLR-2, TLR-4 and TLR-9 on monocytes and neutrophils was analyzed by flow cytometry.

Results

Median age was 64 (IQR 48–74) years and 76.2% of patients were male. Median NT-proBNP was 4941 (IQR 1298–12273) pg/mL and 30-day mortality was 33.3%. TLR-4 expression on monocytes in survivors (740 IQR 694–854) was significantly lower than in non-survivors (871 IQR 723–979; p<0.05). TLR-2 and TLR-9 expression on monocytes and TLR expression on neutrophils was not associated with survival. TLR-4 expression on monocytes was significantly associated with survival independent of age, sex, creatinine and NT-proBNP levels.

Conclusion

Monocyte TLR-4 expression predicts mortality in patients admitted to a cardiac ICU for severe acute heart failure. This suggests that activation of the innate immune system by TLR-binding of DAMPS may play a significant role in critically ill acute heart failure patients.
P791Long-term prognostic value of pulmonary-systemic pressure ratio in patients admitted for acute decompensated heart failure with reduced or preserved left ventricular ejection fraction
Authors: Yamada T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Abe M , Yamamoto K , Kiyomi K , Kawahira M , Tanabe K , Fukunami M
Published: October 2019

Background

Concomitant presence of pulmonary hypertension in heart failure is associated with increased adverse events and may be related to interventricular uncoupling and impaired cardiac efficiency. It has recently been shown that an increased mean pulmonary artery pressure to mean systemic arterial pressure ratio (MPS ratio), a marker of interventricular coupling and efficiency, is associated with worse clinical outcomes in patients with advanced heart failure. However, there is little information available on the long-term prognostic value of MPS ratio in patients with acute decompensated heart failure (ADHF), relating to reduced or preserved left ventricular ejection fraction (HFrEF or HFpEF).

Methods and results

We studied 240 patients admitted for ADHF, who underwent right heart catheterization and were discharged with survival (HFrEF (LVEF≤40%); n=110, HFpEF (LVEF>40%); n=130). MPS ratio was obtained at the admission. During a mean follow-up period of 5.2±4.4 yrs, 59 patients had cardiovascular death (CVD). In both groups with HFrEF and HFpEF, MPS ratio was significantly greater in patients with than without CVD (HFrEF; 0.453±0.101 vs 0.382±0.116, p=0.0035, HFpEF; 0.374±0.118 vs 0.323±0.083, p=0.0091). At multivariate Cox regression analysis, MPS ratio was significantly associated with CVD, independently of eGFR and serum sodium level in HFrEF and HFpEF groups. Patients with high MPS ratio (>0.386 in HFrEF and >0.415 in HFpEF determined by ROC curve analysis) had a significantly increased risk of CVD than those with low MPS ratio in both groups.

Conclusions

MPS ratio could provide the long-term prognostic information in patients admitted for ADHF, regardless of reduced or preserved LVEF.
P793Prediction of prognosis using combined objective nutritional score in the patients with acute decompensated heart failure
Authors: Abe M , Yamada T , Morita T , Furukawa Y , Tamaki S , Iwasaki Y , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Yamamoto K , Fukunami M
Published: October 2019

Background

It has been reported that the objective nutritional indices such as the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI) and Prognostic Nutritional Index (PNI) are useful for the prediction of prognosis in patients with heart failure. However, there is no information available on the prognostic value of the combination of these objective nutritional indices in patients with acute decompensated heart failure (ADHF).

Purpose

We sought to assess the usefulness of the Combined Objective Nutritional Score for the prediction of post-discharge clinical outcome in ADHF patients.

Methods

We studied 361 consecutive patients who were admitted for ADHF and survived to discharge. Venous blood sampling, echocardiography, and measurement of body weight were performed just before discharge. CONUT score, GNRI and PNI were calculated as previously reported. We determined the Combined Objective Nutritional Score by assigning 1 point each for high CONUT score (2–12), low GNRI (≤98) or low PNI (≤38). Patients were followed-up for up to 5 years. The study endpoint was all-cause death.

Results

During a follow-up period of 2.4±1.3 years, 106 patients had all-cause death. Multivariate Cox analysis showed that the Combined Objective Nutritional Score was independently associated with all-cause death after adjustment for age, gender, history of coronary artery disease, left ventricular ejection fraction, brain natriuretic peptide level and estimate glomerular filtration rate (p<0.0001). When the patients were stratified into the three groups based on the Combined Objective Nutritional Score (normal nutritional status: 0 point, mild-to-moderate malnutrition: 1–2 points, severe malnutrition: 3 points), the incidence of all-cause death appeared to increase in relation to the Combined Objective Nutritional Score (normal: 0%, mild-to moderate: 23%, severe: 52%, p<0.0001, Figure). Patients with severe malnutrition showed 2.9 fold (95% CI 1.8–4.6) increase in the total mortality in comparison to patients with mild-to-moderate malnutrition.

Figure 1

Conclusion

This study showed that the Combined Objective Nutritional Score is a useful tool to risk stratify the patients hospitalized with ADHF.
P803Automatic measurement of blood pressure for one hour in the clinic predicts results of 24-hour ABPM in elderly hypertensive patients
Authors: Stender B S , Stender J
Published: October 2019

Introduction

The gold standard in non-invasive assessment of blood pressure (BP) is 24-hour ambulatory BP measurement (24h-ABPM) due to frequent “office-” or “white coat hypertension” effects by measurement in the clinic. But 24h-ABPM is demanding, patients may report discomfort and stress from disturbed sleep. We compared BP measured automatically during one hour (1h-BP) in the waiting room of our clinic with that of 24h-ABPM among elderly hypertensives. Our aim was to investigate whether this less stressful procedure may replace 24h-ABPM in the outpatient follow-up of hypertensives.

Hypotheses

I) Mean diastolic and systolic BP values measured during one hour in a clinic equal those obtained by 24h-ABPM. II) The minimal BP during 1h-BP measurement equals mean 24h-BP during sleep.

Material and methods

The population comprised patients referred with known or suspected hypertension. Office BP was measured with Omron M7 Intelli IT. An ABPM apparatus reprogrammed to every 5 min. for one hour was mounted, and 1h-BP was obtained with the patient seated in the waiting room. 24h-ABPM was then performed at home. 110 patients were considered, 11 were excluded due to reported pain, stress or changes of medication, leaving 99 (m/f 32/66, age (SD) 70 (11)) for analysis. Sample size was set in a pilot study by a=0.05, b=0.05, effect size of BP differences systolic 5 (SD 13) and diastolic 3 (SD 8) mmHg. Results were analyzed with Student's paired t-test.

Results

We found a significant BP drop from office- to 1h- and 24h- BP measurements, i.e. a “white coat” effect. However, mean systolic 1h-BP and mean systolic 24h-BP did not differ, neither did minimal systolic 1h-BP and mean systolic 24h-BP during sleep. Mean diastolic 1h-BP was 4 mm Hg higher than that of 24h-ABPM, and minimal diastolic 1h-BP was 4 mmHg higher than mean diastolic 24h-BP during sleep.

mmHg avg (SD) Office-BP 1h-BP mean 24h-BP mean 1h-BP minimum 24h-BPs mean during sleep Systolic 155 (18) 136 (13)* 135 (11)* 127 (12) 127 (13) Diastolic 90 (11) 80 (9)* 76 (8)* 74 (9) 70 (7) *“White-coat effect” significant in comparison with office-BP. No difference between mean systolic 1h-BP and mean systolic 24h-BP, p=0.67. No difference between mean diastolic 1h-BP minus 4 and mean diastolic 24h-BP, p=0.92. No difference between systolic 1h-BP minimum and mean systolic 24h-BP during sleep, p=0.65.

Conclusion

BP measurement for one hour in the waiting room by an ABPM apparatus may provide sufficient elimination of “office-” or “white coat effects” to replace 24h-ABPM in selected instances. The finding should be challenged in different clinical subpopulations to ensure general applicability.
P804The significance of 24h blood pressure variability improvement regarding target organ damage indices three years after medical treatment initiation in essential hypertension
Authors: Triantafyllidi H , Schoinas A , Benas D , Birba D , Voutsinos D , Ikonomidis I
Published: October 2019

Background

Blood pressure variability (BPV) has been associated with development, progression and severity of cardiac and vascular organ damage and with an increased risk of cardiovascular events and mortality, independently adding to cardiovascular risk, over and above the contribution of elevated mean BP levels. We aimed to explore any correlation between differences in BPV and target organ damage indices (TOD) in hypertensive patients three years after medical treatment initiation.

Methods

At baseline and before medical treatment initiation, we measured 24h average SBP and DBP as well as 24h systolic BPV after 24h ambulatory blood pressure monitoring (ABPM) in newly diagnosed and never treated hypertensive patients (n=171, mean age=52+12 years, 110 males, 24h average SBP/DBP=138+10/87+9 mmHg, 24h systolic BPV=15+3) who were also subjected to arterial stiffness by carotid-femoral pulse wave velocity (PWV), left ventricular hypertrophy by left ventricular mass index (LVMI) and coronary flow reserve (CFR) estimations. All the above tests were repeated approximately three years later after treatment initiation.

Results

Patients were characterized as controlled (n=113, mean age=54+12 years, 62 males, 24h average SBP/DBP=118+6/71+6 mmHg) or non-controlled hyperensives (n=58, mean age=48+11 years, 48 males, 24h average SBP/DBP=133+8/83+7 mmHg) based on ABPM results three years later (controlled BP=24h average BP<130/80 mmHg). In the whole population, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.01) were decreased while systolic BPV difference was related with LVMI difference (r=0.27, p<0.001). In controlled hypertensives, 24h average SBP/DBP, systolic BPV (p<0.001) and LVMI (p=0.02) were decreased while systolic BPV difference was related with LVMI difference (r=0.35, p<0.001). In non-controlled hypertensives, 24h average SBP (p=0.001), DBP p<0.001) and systolic BPV (p=0.04) were decreased while PWV was increased (p=0.03) and no correlations were found between systolic BPV and TOD.

Correlation between BPV and LVMI

Conclusions

It seems that antihypertensive-induced systolic BPV improvement relate with cardiovascular risk decrease occur only in the setting of blood pressure treated within normal limits and confirmed by ABPM. Our study confirms that left ventricular mass between other TOD primarily improves due to successful antihypertensive treatment.
P806High normal blood pressure and vascular parameters in patients with erectile dysfunction
Authors: Ioakeimidis N , Vlachopoulos C , Terentes-Printzios D , Angelis A , Georgakopoulos C , Koutagiar I , Rokkas K , Lazaros G , Rokkas K , Tousoulis D
Published: October 2019

Purpose

High blood pressure (BP) is a common risk factor for erectile dysfunction (ED) which is considered as an early clinical manifestation of generalized vascular disease. High–normal BP (130–139/85–89 mmHg) is associated with high rates of progression to hypertension. Aim of the study is to examine vascular and structure parameters of patients with high-normal BP complaining of ED.

Methods

We assessed macrovascular and microvascular (penile vascular damage) changes in four age-matched groups without a history of diabetes and cardiovascular disease; Normal BP (n=162), high-normal BP (n=87), stage I hypertension (n=49) and stage II and III hypertension (n=44). All hypertensive patients were not receiving antihypertensive therapy. Indices of vascular function and structure including carotid-femoral pulse wave velocity (PWV), augmentation index (AIx), carotid intima media thickness (cIMT) and microvascular damage (penile vasculature) were evaluated in all patients. Microvascular damage was examined by measuring penile peak systolic velocity (PSV) with a dynamic penile color Doppler ultrasonography after intracavernous injection of prostaglandin E1. Lower PSV values indicate severe penile vascular disease.

Results

Body-mass index (BMI) was significantly higher in patients with hypertension and patients with high- normal BP compared to subjects with normal BP. Smoking prevalence and LDL-C level were not different between the four subgroups. Figure shows a progressive increase in PWV and cIMT from normal BP group, to patients with high- normal BP and to untreated patients with hypertension. Compared to patients with normal BP, patients with high- normal BP had significantly higher PWV (p<0.01), cIMT (p<0.05), AIx (p<0.05) and lower penile PSV (p<0.01). Interestingly, figure shows that the individuals with high- normal BP level and patients with stage I hypertension had similar AIx and penile PSV denoting no difference in central haemodynamics and penile vasculature between the two groups.

High-normal BP and vascular parameters

Conclusions

Middle-aged men with high-normal BP have significant microvascular and macrovascular damage compared to subjects with normal BP. The ultrasonographically documented functional changes in the vascular wall of the smaller in size penile vasculature are similar to that of men with stage I arterial hypertension. These findings bring new insights into the clinical significance of high- normal BP, which might be a premising therapeutic target for men with ED who are considered to be at a higher cardiovascular risk.
P814Analysis of patients with tako-tsubo syndrome in terms of the triggering mechanism
Authors: Polednikova K , Tousek P , Kocka V , Kroupa J , Kozel M , Novackova M
Published: October 2019

Introduction

Tako-tsubo syndrome (TTS) might be caused by two different trigger mechanisms. There is very little data available on patient characteristics and prognosis regarding the trigger mechanisms.

Purpose

Comparison of patients with TTS in terms of different trigger factor – emotional stress vs. psychical stress caused by severe non-cardiac condition.

Method

Data were obtained from the Tako-tsubo registry of patients hospitalized in Cardiocenter University Hospital from 2013 to 2018, in total 86 patients were diagnosed with TTS. The patients were divided into 2 groups according to the triggering cause, that we thoroughly examined in each case. In the first group, there were patients with TTS triggered by emotional stress (such as death in the family or anxiety disorders) and in the second group there were patients whose TTS was caused primarily by non-cardiac conditions of various etiology, such as neurological, infectious or postoperative issues.

Results

Out of 86 patients, there were 20 (23,3%) patients excluded, for we weren't able to establish the triggering cause. In 26 (30,2%) patients, the trigger was psychological and 40 (46,5%) patients suffered from non-cardiac condition. According to the collected data there were no significant differences amongst basic demographic facts. Women represented the majority in both groups – 92% vs 95%, age of 70,6±0,8 vs 71,9±0,7 years (p=0,650). There were no significant differences in the hs-TnT 624ng/l ± 49,9 vs 610,2±17,3ng/l (p=0,959). There were significant differences discovered in the average NT-proBNP level – 2691±220,5pg/ml vs 10610±599pg/ml (p<0,05). The patients with non-cardiac conditions developed acute complications more frequently, especially a respiratory failure requiring mechanical ventilation 20% vs 3,8% (p<0,05). In total, 8 (9,3%) patients with TTS died, of whom all had a physical stress factor of p<0,05.

Conclusion

Physical stress in patients with severe non-cardiac conditions is a more frequent trigger for TTS than emotional stress. Patients with TTS induced by physical stress have a significantly worse prognosis.
P819Post-procedural cholesterol and inflammatory risk in acute myocardial infarction patients undergoing percutaneous coronary intervention
Authors: Chen R , Liu C , Zhou P , Tan Y , Sheng Z , Li J , Zhou J , Chen Y , Song L , Zhao H , Yan H
Published: October 2019

Objective

This study sought to depict the combined association of post-procedural cholesterol and inflammatory risk with clinical outcomes among acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI) and pick out patients with highest comprehensive risk.

Methods

A total of 4802 AMI-PCI patients were divided into quartiles according to post-procedural low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP) level respectively and in combinations for risk analysis. Univariate and adjusted multivariate analysis with Cox model were performed. Hazard ratio (HR) for short-term (90 days) and long-term (1 year) were compared for major adverse cardiovascular events (MACE), including cardiac death, recurrent myocardial infarction and ischemic stroke.

Results

A significant change in the hazards of 90-day MACE was seen among patients in the highest quartile of post-procedural LDL-C [HR: 0.526 (0.291, 0.951), p=0.034] and highest quartile of CRP [HR: 2.119 (1.150, 3.920), p=0.016]. For 1-year outcomes, only a trend for increasing risk was seen in patients with higher post-procedural CRP (p-trend = 0.016). Combination analysis for cholesterol/inflammatory risk showed that patients lying simultaneously in the lowest quartile of LDL-C and highest quartile of CRP gained the highest risk in the 90-day [HR: 3.16 (1.124, 8.886), p=0.029] and 1-year [HR: 2.515 (1.153, 5.486), p=0.020] follow up.

Hazard ratios (HR) for short-term (90 days) and long-term (1 year) primary outcomes according to cholesterol and inflammatory risk 90 days 1 year Type of risk Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend Unadjusted HR (95% CI) P value Adjusted HR (95% CI) P value P for trend LDL, mmol/L   Quartile 2 0.742 (0.441, 1,248) 0.260 0.663 (0.390, 1.125) 0.128 0.033 0.722 (0.364, 1.125) 0.150 0.683 (0.435, 1.072) 0.097 0.251   Quartile 3 0.653 (0.381, 1.121) 0.122 0.597 (0.344, 1.038) 0.068 0.850 (0.557, 1.229) 0.453 0.850 (0.550, 1.312) 0.462   Quartile 4 0.517 (0.288, 0.928) 0.027 0.526 (0.291, 0.951) 0.034 0.673 (0.427, 1.061) 0.088 0.708 (0.444, 1.131) 0.149 CRP, mg/L   Quartile 2 1.365 (0.717, 2.599) 0.334 1.295 (0.654, 2.522) 0.448 0.007 1.063 (0.656, 1.722) 0.805 0.998 (0.608, 1.636) 0.992 0.016   Quartile 3 1.306 (0.681, 2.502) 0.442 1.279 (0.654, 2.499) 0.472 0.999 (0.612, 1.630) 0.996 0.968 (0.586, 1.597) 0.897   Quartile 4 2.354 (1.312, 4.221) 0.004 2.119 (1.150, 3.920) 0.016 1.657 (1.069, 2.570) 0.024 1.528 (0.967, 2.413) 0.069 Multivariate analysis was adjusted for age, sex and traditional cardiovascular risk factors.

Combined cholesterol/inflammatory risk

Conclusion

AMI-PCI patients with lower post-procedural LDL-C and higher CRP might encounter greater cardiovascular risk. Patients with the lowest LDL-C and highest CRP gained extremely high risk and required special attention.
P820The prevalence and management of familial hypercholesterolemia in patients with acute coronary syndrome in Poland: results of the TERCET Registry
Authors: Dyrbus K , Gasior M , Desperak P , Osadnik T , Banach M
Published: October 2019

Background

Prevalence of familial hypercholesterolemia (FH) is high among patients with CAD. However, data on FH among ACS patients are still scarce. Therefore, we aimed to assess the prevalence, lipid-lowering therapy and short- and long-term outcomes in FH patients with ACS.

Methods

We finally included 19,781 consecutive patients from the Hyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry for years 2006–2018, including 7,319 patients with ACS: 3,085 with STEMI, 2,256 with NSTEMI, and 1,978 due to unstable angina (UA) (stable CAD group [n=12,462] was treated as a reference). FH diagnosis was based on Dutch Lipid Clinic Network (DLCN) score.

Results

The overall occurrence of probable/definite FH and possible FH were 1.2% and 13.7% respectively. In ACS patients 1.6% had probable/definite FH and 17.0% possible FH. The highest occurrence of FH was observed in STEMI subgroup, where 20.6% of the patients had ≥3 points according to the DLCN criteria. In patients with definite/probable FH, 98.1% were administered statins at discharge (including 57.5% prescribed intensive statin therapy in comparison to only

23.7% in non-FH patients). Patients with definite/probable FH had higher in-hospital and 30-day mortality than patients without FH (3.5% vs 1.2%, p=0.0046 and 4.4% vs 1.7%, p=0.024, respectively). However, no significant differences in investigated outcomes were observed between the FH groups in the 12-month and 36-month follow-up.

The number of patients with FH

Conclusion

The prevalence of FH (definite/probable/possible) in the Polish very high-risk population is even 14.9% and is significantly higher in patients with ACS than in patients with stable CAD. High intensive lipid lowering therapy, including the combination therapy allows improving long-term outcomes in patients with FH.
P821Treatment patterns of lipid lowering therapy in patients with coronary artery disease above vs. below 75 years of age
Authors: Mahabadi A A , Wiefhoff D , Dykun I , Hendricks S , Al-Rashid F , Totzeck M , Rassaf T
Published: October 2019

Introduction

In patients with coronary artery disease (CAD), lipid lowering therapy is recommended as cornerstone of secondary prevention. Treatment of elderly patients inherits a medical challenge, as they experience higher absolute risk reduction with more intensive lipid lowering regimes but may be more prone to side effects by therapy.

Purpose

To evaluate the treatment patterns in lipid lowering therapy comparing CAD-patients above vs. below 75 years of age.

Methods

We retrospectively included patients with known CAD, admitted to the West German Heart and Vascular Center in the years of 2009–2010 (n=500), 2012–2013 (n=500), and 2015–2016 (n=500). LDL-cholesterol levels and intensity of stain therapy (based on dosage and type of statin) were assessed from all available hospital records. Lipid levels and treatment regimens were evaluated comparing patients ≥75 vs. <75 years of age. The analysis was approved by the local ethics committee (17–7458-BO).

Results

A total of 1,500 patients (mean age: 68.4±11.2 years, 75.8% male) from 813 referring treating primary care physicians in 98 cities of Germany were included in our analysis. 983 patients were <75, whereas 517 were ≥75 years of age. Elderly patients were less likely male (67.9% vs. 79.9%, p<0.0001), had lower BMI (26.8kg/m2 vs. 28.4kg/m2, p<0.0001), and less likely current smokers (7.6% vs. 19.2%, p<0.0001, for patients ≥75 vs. <75 years of age, respectively). LDL-cholesterol levels were not significantly different between age groups (≥75: 96.1±35.1 mg/dl; <75: 98.9±35.7mg/dl, p=0.14). In contrast, elderly patients had higher HDL-cholesterol levels (49.9±15.1 mg/dl vs. 46.7±15.2, p=0.0002) and markedly lower triglycerides (135.6±90.0mg/dl vs. 171.4±124.6mg/dl, p<0.0001). Simvastatin was most frequently prescribed in both age groups (54.9% vs. 50.7%, p=0.16), followed by Atorvastatin (31.6% vs. 33.3%, p=0.53). Elderly patients received significantly lower dosages of statin (28.8±12.8mg vs. 31.4±13.7mg, p=0.0007). Interestingly, patients ≥75 years of age archived LDL<70mg/dl slightly more frequently than younger patients (24.0% vs. 20.1%, p=0.09). Excluding patients with myocardial infarction at presentation, CK-levels were not relevantly different between age groups (131.9±450.0U/l vs. 127.5±111.4U/l, p=0.78). Excluding patients with signs of systemic inflammation, high-sensitive CRP levels did not differ when comparing patients ≥75 vs. <75 years of age (0.15±0.12mg/dl vs. 0.14±0.12mg/dl, p=0.33).

Conclusion

Evaluating lipid lowering treatment patters of 1500 patients from 813 treating physicians, we observed that patients ≥75 years of age receive lower doses of statin therapy, but reached slightly lower LDL-cholesterol-levels. However, the majority of elderly patients miss current recommendations regarding LDL-thresholds. Interestingly, no signs of a higher frequency of statin-induced myopathy in the elderly were observed in our analysis.
P834Secondary prevention medications of cardiovascular diseases in China: findings from China PEACE million persons project
Authors: Lu J , Zhang L , Lu Y , Su M , Li X , Li J , Liu J , Zhang H , Nasir K , Masoudi F , Krumholz H , Zheng X
Published: October 2019

Background

Cardiovascular diseases (CVD) is the leading cause of death in China. Secondary prevention medications can improve the prognosis of CVD, yet little is known about the current use, variation and associated factors of these therapies in China.

Purpose

The aim of this study was to describe the current use of secondary prevention medications among patients with established CVD in the community setting in China, assess variations across population subgroups, and identify the individual characteristics associated with these therapies.

Methods

We studied 2.6 million participants aged 35–75 years from all 31 provinces in the China Patient-Centered Evaluative Assessment of Cardiac Events (PEACE) Million Persons Project, a government-funded public health program conducted from 2014 to 2018. Participants self-reported their history of ischemic heart disease (IHD) or ischemic stroke (IS) and medication use in an interview. Among participants with IHD and/or IS, we assessed the reported use of secondary prevention medications (anti-platelet drugs and statins) in the overall population and in 1,530,408 population subgroups, defined by all possible combinations of 16 factors (age, sex, urbanity, geographic region, ethnicity, occupation, annual household income, education, marital status, medical insurance, current smoker, current drinker, history of hypertension, history of diabetes, body mass index and years since diagnosis). Multivariable mixed models with a logit link function and community-specific random intercepts were fitted to assess the associations of demographic, socioeconomic and health behavior factors with the reported use of secondary prevention mediations.

Results

Among 2,613,035 screened participants, 2.9% (74,830) had history of IHD and/or IS (1.2% for IHD, 2.4% for IS). Overall, the reported use rate either anti-platelet drugs or statins was 21.9% (18.3% anti-platelet drugs, 11.0% statins, and 7.4% both). Among the 1,530,408 population subgroups, the use of secondary prevention medications varied substantially (3.4% to 52.0%). Multivariable analyses found that that younger people, women, those living in rural areas, current smokers, current drinkers, people without hypertension or diabetes, and those with established CVD for more than 2 years were less likely to take anti-platelet drugs or statins (Figure).

Forest plot of multivariable mixed model

Conclusions

The current use of secondary prevention drugs is suboptimal and varies substantially across population subgroups in China. Our study identifies target populations for interventions to improve secondary prevention of CVD.

Acknowledgement/Funding

This study was supported by the Ministry of Finance of China and National Health Commission of China
P836Glasgow Prognostic Score predicts the readmission caused by acute decompensated heart failure after myocardial infarction
Authors: Namiuchi S , Sunamura S , Ushigome R , Noda K , Takii T
Published: October 2019

Purpose

The Glasgow Prognostic Score (GPS), combination of C-reactive protein (CRP) and serum albumin concentration, provides predictions of prognosis in patients with heart failure. We evaluated the GPS of patients with acute myocardial infarction (MI).

Methods

We investigated the prognosis of 1182 patients with acute MI in our institution. These patients were classified into three groups by GPS at admission. GPS was defined as follows: patients with both elevated CRP (>1.0mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a score of 2, patients with only one of these biochemical abnormalities were allocated a score of 1, and patients with neither of these abnormalities were allocated a score of 0.

Results

Of the patients, 70.3% (n=831), 19.2% (n=227), and 10.5% (n=124) had GPS of 0, 1, and 2, respectively. In-hospital mortality of GPS 0, GPS 1, and GPS 2 were 4.7%, 18.1%, and 31.5%, respectively (p<0.0001). Relative to a GPS of 0, the hazard ratios for the readmission caused by acute decompensated heart failure (ADHF) were 3.27 (95% CI: 2.04–5.18) for a GPS of 1 and 3.62 (95% CI: 1.93–6.42) for a GPS of 2 in the age- and sex- adjusted Cox proportional hazard model. After propensity score matching, baseline characteristics were balanced, and 250 paired patients constituted GPS 0 group and GPS 1–2 group. Patients with GPS1 or 2 had a higher risk of the development of ADHF compared with patients with GPS 0 (Hazard ratio: 1.96, 95% confidence interval: 1.13–3.47, p=0.017).

Conclusions

The GPS, which is based on systemic inflammation, is useful for predicting the development of acute decompensated heart failure after myocardial infarction.
P839Lifetime cost-effectiveness of diagnostic artificial intelligence tool for evaluating individuals with stable chest pain. The co-operative ARTICA registry database
Authors: Mazzanti M , Shirka E , Gjergo H , Pugliese F , Goda A
Published: October 2019

Background

Non-invasive cardiac imaging testing has been often favored as an initial test for symptomatic patients with at least intermediate pre-test likelihood (pt-lk) of obstructive CAD. Despite this condition, uncertainty remains regarding the optimal testing strategies. It is known that intelligence applied with automatic decision support system (AI DSS) is able to correctly identify absence of significant CAD versus standard care (SD) in patients with stable chest pain (SCP). No evidence of long-term cost-effectiveness about AI DSS has been published in this setting.

Purpose

The aim is to determine the cost-effectiveness of AI DSS when applied to individuals without known CAD presenting with stable chest pain syndrome.

Methods

1725 subjects, 982 males, age 61±12 years, with SCP were referred for clinical evaluation by human standard care (SD) and AI DSS administration during same day visit on a 2 years period. Exercise treadmill test (ETT), coronary tomographic angiography (CTA), invasive coronary angiography (ICA), stress echocardiography (SE)/gated myocardial perfusion scintigraphy (gMPS) and follow up/no tests (FNT) alone and combined strategies were analyzed. For the post-diagnosis follow up period of 16±3 months, we employed a Markov model based on 1-year cycle to account for outcomes for those correctly diagnosed with CAD. All subjects performed CTA to verify presence of CAD. CAD was defined as ≥70% stenosis in at least one major epicardial coronary artery vessels. Monte Carlo simulation was performed to derive mean values for costs and QALYs at different CAD prevalence of 15%, 50% and 80%.

Results

Data from ARTICA registry about lifelong costs based upon different diagnostic strategies in subjects with 15%, 50% and 80% CAD pt-lk are shown in Table.

Lifelong costs related to strategies FNT (€) ETT-SE/gMPS-ICA (€) SE/gMPS-ICA (€) CTA-ICA (€) CTA-SE/gMPS-ICA pt-lk CAD 15% AI DSS 350 8,250 8,850 10,450 11,020 SD 1,015 11,100 12,715 12.215 12,215 pt-lk CAD 50% AI DSS 1,610 17,375 19,540 20,410 20,110 SD 1,855 19,650 21,340 22,950 22,115 pt-lk CAD 80% AI DSS 2,910 28,210 30,875 31,215 31,765 CD 4,110 32,715 34,815 35,755 35,660

Conclusion

Data from ARTICA registry demonstrate that automatic use of AI DSS result in improved costs and enhanced effectiveness when compared with human SD in subjects with stable chest pain.