bluuebunny/crossref_metadata_2025 huggingface dataset:
P4352Usefulness of speckle tracking echocardiography in the detection of ventricular mechanics changes after percutaneous intervention of coronary chronic total occlusions
Authors: Mahia P , Salinas P , Gonzalo N , Islas F , Escaned J , Perez De Isla L , Macaya C
Published: October 2019

Background

Previous studies show contradictory results of the effect of chronic total occlusions (CTO) revascularization on LVEF. Deformation parameters based on speckle tracking (2D-ST) echo allows the evaluation of the systolic regional function.

Purpose

To examine the usefulness of 2D-ST to detect changes in regional ventricular mechanics in a consecutive cohort of patients with successful CTO percutaneous revascularization.

Methods

Prospective study that included 13 consecutive patients (72±8 y, 85% men). Revascularization was justified based on the evidence of viability of the underlying territory. 2D-ST was performed before, one and three months after of the procedure. Based on 16 segments model (n: 208), these were classified in two groups (dependent/non-dependent) according to their relationship with the treated CTO. Strain rate (Sr) and Strain (S) of the three myocardial layers were measured.

Results

208 segments analyzed. 62 (30%) perfusion dependent, (mean 5 segments/patient), non-dependent: 146 (70%). During follow-up (median: 3.3 m), there were no significant differences with respect to LVEF (56±6 vs. 59±6, p: 0.2). Although non-dependent segments showed no significant changes of deformation parameters after the procedure, dependent segments showed an increase (Δ) of both the S and Sr, being statistically significant the Δ of the three layers S at 3 months vs. non-dependent.

Table 1 PRE POST p Δ Non-Dependent segments (N: 146)   S-epicardial −16.6±4.9 −16.0±4.0 0.06 0.6±4.0   S-mesocardiac −17.4±4.8 −16.8±4.2 0.08 0.6±3.9   S-endocardial −18.1±5.1 −17.7±4.9 0.337 0.4±4.5   Sr −1.15±0.4 −1.09±0.4 0.080 0.07±0.47 Dependent segments (N: 62)   S-epicardial −13.7±5.8 −16.3±4.5 <0.001 −2.6±5.2*   S-mesocardiac −14.7±6.1 −17.0±4.5 <0.05 −2.3±5.2*   S-endocardial −15.8±6.7 −17.9±4.9 <0.05 −2.1±5.6*   Sr −0.98±0.4 −1.03±0.4 0.353 −0.05±0.42 *p<0.05 ΔNon-dependents vs. ΔDependents.

S (%) improvement post RCA CTO treatment

Conclusions

This study shows that CTO treatment improves regional myocardial function in LV segments dependent on CTO at three months of follow-up, without changes in LVEF. 2D-ST allows to examine the effect of flow restoration, providing new information on the potential short-term benefits of this strategy
P4366Application of 3D-dual volume layout imaging for rapid intraprocedural guidance in Mitraclip procedure
Authors: Gavazzoni M , Zuber M Z , Miura M M , Pozzoli A P , Taramasso M T , Ho E C H , Maisano F M
Published: October 2019

Introduction

Intraprocedural guidance and monitoring with transesophageal echocardiography (TEE) and invasive hemodynamic assessment are currently the best available options for evaluating procedural success of percutaneous mitral valve (MV) repair with Mitraclip System (Abbott Vascular, Santa Clara, CA, USA). However, despite its crucial importance, echocardiography has some limitations in immediate evaluation of residual jets after clip implantation, so that, in absence of validated method for double orifice effective regurgitant orifice (ERO) assessment, the most reliable parameter that is currently used is the mean trans-valvular gradient.

Purpose

This prospective study aimed to assess the role of a new echocardiographic parameter obtained from 3D-Color-Full volume imaging of MR for evaluation of outcomes of mitraclip procedures, comparing it with invasive LAP measurements.

Material and methods

We prospectively performed the computation of a new parameter in patients with symptomatic moderate-severe to severe primary or secondary mitral regurgitation (MR) underwent MitraClip procedure. This parameter is easy and fast to be obtained out of 3D dataset and represents the 2D area of the proximal isovelocity surface zone visualized from the ventricular view, without any imaging processing (“3D dual volume PISA area”) (figure). It was obtained as following: i) acquisition of 3D-zoomed-color image of MR jet with adequate frame rates; ii)displaying of the volume sampling in “dual volume layout” so one can see the “ventricular aspect” of the jet area corresponding to proximal isovelocity surface “zone”; iii) awareness of correct alignment to the direction of the flow in proximal zone; iiii) freezing and direct measurement of this area (summarize if more than 1 orifice) (1 attached). We compared the variation of this parameter from the beginning to end of procedure with the variation of LAP measurements, that is currently the most important parameter for assessing outcome of procedures.

Results

The study includes dataset of 11 patients. The baseline value of 3D dual volume PISA area was 1,191±0,40 cm2 and the mean change we obtained was 0,65±0,30 cm2 (mean of 77% of reduction until the end of procedure). Mean values of LAP were slightly decreased in all cases: basal m-LAP was 12±3,3 mmHg and decreased by 15%. Despite the small number of patients, we observed a significant correlation between the changes of LAP and the change of 3D dual volume PISA area (R: 0.6, p: 0,048).

Conclusions

This is the first demonstration of the usefulness of echocardiographic parameter obtained by 3Ddual volume layout imaging for rapid intraprocedural guidance in Mitraclip procedure. This parameter is related to hemodynamic variations that it currently considerable surrogate of outcomes. These data need to be confirmed by a larger study.
P4378Comparison between left bundle branch pacing and His bundle pacing using two-dimensional speckle tracking echocardiography
Authors: Cheng Y F , Chen H Y , Zhu M R , Chen X Y , Su Y G , Pan C Z , Shu X H , Ge J
Published: October 2019

Background

Although his bundle pacing (HBP) can achieve physiological electrical activation of the ventricles, its clinical use is limited by lower success rates, high and unstable pacing thresholds and loss of capture. Left bundle branch pacing (LBBP) has been proved to be able to correct Left bundle branch block (LBBB) and generate a narrower QRS duration than conventional RV pacing. However, its effects on ventricular synchronism and contraction function remains unknown. The current study is aimed to compare the echocardiographic characteristics between HBP and LBBP, and to explore whether LBBP leads to a comparable cardiac synchrony and deformation in comparison with HBP.

Methods

Forty-six pacing-indicated patients were prospectively enrolled. Twenty-nine patients underwent LBBP (17 male patients, mean age 69.6±13.7yrs, the LBBP group) and 17 patients underwent HBP (13 male patients, mean age 70.4±14.7yrs, the HBP group). LBBP was achieved by trans-septal method in the basal ventricular septum. Left ventricular end diastolic volume (LVEDV), left ventricular end systolic volume (LVESV), left ventricular ejection fraction (LVEF), and tricuspid annulus plane systolic excursion (TAPSE) were obtained. Strains and time to peak strains of right ventricular free wall and 16 left ventricle segments were analyzed using two-dimensional speckle tracking echocardiography (2D STE). The standard deviation of time to peak strains of 16 left ventricular segments was calculated as PSD.

Results

Compared to the baseline, time to peak longitudinal strain (TTPS) of apical septum, apical lateral wall were shortened after 6 months of HBP, while they didn't change significantly after 6 months of LBBP. After pacemaker implantation, the LBBP group had a delayed TTPS of apical septum, apical lateral wall and basal RV free wall than the HBP group (LBBP vs. HBP: apical septum,358.44±61.98ms vs. 296.43±29.47ms; apical lateral wall, 373.11±55.80ms vs. 299.00±83.45ms; basal RV free wall, 404.31±72.93ms vs. 334.50±39.95ms, all p<0.05).However, PSD was comparable between the two groups (p>0.05).

Compared to the baseline, global left ventricular longitudinal strain (LVGLS) and longitudinal strain of RV free wall (RVLS) were deteriorated after 6 months of HBP, while they were preserved in the LBBP group. After 6-month pacing, LVGLS and RVLS were significantly stronger in the LBBP group than those in the HBP group. (LVGLS, −16.10±3.75% vs. −13.18±4.11%; RVLS, −17.50±5.46% vs. −13.70±4.35%, both p<0.05).

Conclusion

Patients received LBBP had a comparable left ventricular synchronism and a better myocardial contraction compared to patients with HBP. LBBP may be a promising alternative pacing strategy. Two-dimensional STE is more sensitive than conventional echocardiography in assessing cardiac synchrony and segmental deformation.
P4387Environmental tobacco smoke exposure affects the QT interval during early infancy
Authors: Harada K , Harada Y
Published: October 2019

Background

The association between long QT interval and sudden infant death syndrome (SIDS) has been clearly established. Environmental tobacco smoke (ETS) exposure is associated with increased risk for SIDS. However, there has been little focus on the relationship between the QT interval and ETS exposure during early infancy. To clarify this, we examined the QT interval with ETS exposure during early infancy.

Methods

Electrocardiographic study was performed in 624 infants (age: 1–5 months) who have been exposed to tobacco smoking since intrauterine life and 1119 age-matched children without ETS exposure. QT data were extracted from the electrocardiogram monitor built-in echocardiogram. Recordings from lead II on the monitor ECG were used to measure the QT interval. The QT intervals of 5 consecutive beats were measured manually. The QT interval was measured on the first, second, third, fourth, and fifth month. The corrected QT interval (QTc) was calculated by dividing the QT interval by the square root of the RR interval (Bazett's formula). The data of the number of cigarettes per day were collected by a questionnaire.

Results

In the total study population, the mean QTc showed the highest peak at the second month. The mean QTc at the first and second month (399±21 and 402±18 msec) was significantly longer (p<0.05) than that at the third, fourth, and fifth month (394±19, 393±21, and 392±22 msec) as shown in Figure 1A. The mean QTc in ETS infants at the first, second and third month was significantly greater than that in infants without ETS (404±20 vs. 397±21 msec, 407±19 vs. 399±17 msec and 404±17 vs. 390±18 msec, p<0.01, respectively), but the mean QTc at the fourth and fifth was similar in the 2 groups as shown in Figure 1B. The QTc increased significantly as the category of number of cigarettes per day increased, with a significant prolongation as of the category 6–10 cigarettes per day as shown in Figure 1C.

Figure 1

Conclusions

The present study indicates that the QT interval during early infancy lengthens by ETS exposure. Further study is needed as to whether QT prolongation associated with ETS exposure is a risk factor for SIDS.
P4391Cardiovascular risk factor trends over two decades in patients presenting with acute myocardial infarction: a failure of smoking control, especially in women
Authors: Witassek F , Radovanovic D , Rickli H , Pedrazzini G , Erne P , Muller O , Eberli F R , Roffi M
Published: October 2019

Background

Hypertension, diabetes, dyslipidemia and smoking are established cardiovascular risk factors (CVRF). Little is known about the changes of risk factor profiles over time in patients presenting with acute myocardial infarction (AMI).

Purpose

To analyze the temporal trends of CVRF in patients presenting with AMI over the last 22 years in Switzerland.

Methods

We included data of all AMI patients enrolled between 1997 and 2018 in the Swiss nationwide AMIS Plus registry. The rates of hypertension, diabetes, dyslipidemia and smoking at presentation were descriptively analyzed dividing the data into 2-year periods. Trend analyses were performed using the CHI-square-test and ANOVA. A p-value of <0.005 was considered as statistically significant.

Results

A total of 57,995 patients were included in the analysis (73.6% male). The mean age was 66.0 years (males: 64.0 years, females 71.6 years) and did not differ over the study period. The mean CVRF rates over the study period were as follows: diabetes 20.5% (males: 19.4%, females: 23.6%), hypertension 60.2% (males: 57.0%, females: 69.0%), dyslipidemia 59.4% (males: 60.5%, females: 56.4%), and smoking 39.3% (males: 43.0%, females: 28.7%). While there was no significant change over time in the rates of diabetes for both genders, there were significant increases in the rates of hypertension and dyslipidemia for both males and females (p<0.001 for all comparisons). In terms of smoking, there was no significant trend for males while there was a significant increase in the rate of smoking for females (p<0.001). As a result, the gap in smoking rates between men and women decreased from 19.9% (45.3% vs. 25.4%) in 1997/98 to 7.9% (41.2% vs. 33.3%) in 2017/18.

Trends in the rate of smokers

Conclusions

Among patients presenting with AMI in Switzerland over two decades, the prevalence of hypertension and dyslipidemia increased in both men and women, while diabetes at presentation did not change over the years. We documented a failure of smoking control, with a lack of a reduction in the smoking prevalence among males and a striking increase among women.
P4405Impact of longitudinal changes in metabolic syndrome status over two years on 10-year incident type 2 diabetes mellitus
Authors: Koh K , Kim J
Published: October 2019

Background

Metabolic syndrome (MetS) is a known predictor of diabetes mellitus (DM), but whether longitudinal changes in MetS status modify the risk for incident DM remains unclear. We investigated whether temporal changes in MetS status over two years modify the 10-year risk of incident DM.

Methods

A prospective cohort study was conducted in 7,317 adults aged 40–70 years without DM at baseline. Subjects were categorized into four groups based on repeated longitudinal assessment of MetS status over two years, as defined by the Adult Treatment Panel III guidelines: non-MetS, resolved MetS, incident MetS, and persistent MetS. The hazard ratio (HR) of new-onset DM during 10 years was calculated in each group using Cox models.

Results

During the 10-year follow-up, 1,099 (15.0%) developed DM. Compared to the non-MetS group, the fully adjusted hazard ratios (95% confidence interval) for new-onset DM were 1.27 (1.01–1.61) in the resolved MetS group, 1.78 (1.43–2.22) in the incident MetS group, and 1.85 (1.52–2.26) in the persistent MetS group (P for trend <0.001). The 10-year risk of DM in subjects with resolved MetS was attenuated compared to those with persistent MetS over two years (P<0.001). In addition, the adjusted hazard ratio for 10-year incident DM gradually increased according to the number of MetS components two years later.

Conclusions

Temporal changes in MetS status over two years influenced the 10-year risk of incident DM. Our findings suggest determining the status of MetS regularly and strictly controlling MetS are important in preventing DM.
P4412Association of sleep duration with cardio-metabolic risk leading to development of atherosclerotic cardiovascular disease
Authors: Matsuo R , Tani S , Atsumi W , Matsumoto N
Published: October 2019

Background

Sleep duration, mostly of short duration, has emerged as a potential factor in adverse cardio-metabolic risk. We investigated the relationship between sleep duration and cardio-metabolic risk leading to atherosclerotic cardiovascular disease (ASCVD).

Purpose

We examined the association between sleep duration and cardio-metabolic risk in Japanese men.

Methods

This cross-sectional study was conducted using a sample of 6,907 apparent healthy men who had undergone medical examinations at the Health Planning Center of Nihon University Hospital between April, 2015 and May, 2016. The relationship between waist circumference, homeostasis model assessment of insulin resistance (HOMA-IR), HbA1c, non-high-density lipoprotein cholesterol (non-HDL-C) level, and sleep duration was evaluated.

Results

Both unusually short and long sleep durations were associated with waist circumference, impaired glucose tolerance and high non-HDL-C level (Figure). Compared with men sleeping 7 to 8 hours, the relative risk of abdominal obesity (defined according to the Japanese criteria for metabolic syndrome as a waist circumference of 85cm≥) among men sleeping ≥8 h was 1.27 (95% Confidence interval (CI), 1.05–1.55, p<0.01); the relative risk of a high HOMA-IR (2.0≥) level among men sleeping <5 h was 1.43 (95% CI, 1.00–2.05, p<0.05); among men sleeping ≥8 h the relative risk was 1.38 (95% CI, 1.08–1.77, p=0.01); the relative risk of a HbA1c level of ≥5.6% (defined as “high” by a specialized life style checkup program for the detection of symptoms of metabolic syndrome in Japan) among men sleeping <5 h was 1.39 (95% CI, 1.01–1.65, p<0.05); the relative risk of a non-HDL-C level of ≥170 mg/dL (defined as “high” by the Japanese Arteriosclerosis Society based on a lipid control target value for the primary prevention of ASCVD) among men sleeping ≥8 was 1.40 (95% CI, 1.13–1.76, p<0.01). These analyses were adjusted for age, psychological stress, and the use of cholesterol-lowering, blood-pressure lowering, and anti-diabetic medications.

Conclusion

The results suggest that unusually short and long sleep durations may increase cardio-metabolic risk. To further reduce the risk of ASCVD, it may be of particular importance to emphasize adequate sleep duration.
P4422Myocarditis: a deceitful but not infrequent athletes' enemy
Authors: Pizzamiglio F , Casella M , Dessanai M A , Chihade F , Riva S , Pontone G , Andreini D , Basso C M , Tondo C , Delo Russo A , Zeppilli P
Published: October 2019

Introduction

Myocarditis represents a not negligible cause of sudden death (SD) in athletes, representing the cause of 4%-14% cardiac arrests and deaths in athletes. Preparticipation screening including 12-leads basal electrocardiogram could drastically reduce SD in athletes and screening programs are therefore now recommended by most medical and sport association. At the moment, no data in literature are available about incidence of concealed myocarditis in athletes but there is general consensus about disqualification from competitive sport in the presence of myocardial fibrosis (MF).

Purpose

Purpose of our study was to quantify incidence of MF consistent with past myocarditis in athletes that referred to our Sport Cardiology Center for ventricular arrhythmias (VA) +/− repolarization abnormalities (RA) detected at preparticipation screening.

Methods

In our study we retrospectively evaluated all athletes with VA +/− RA and we quantified how many were found to have MF consistent with myocarditis at cardiac MRI. Furthermore, we evaluated characteristics of presentation in terms of clinical symptoms of myocarditis and frequency and morphology of VA. Finally, we analyzed findings of invasive diagnostic workout when performed.

Results

In the last two years we evaluated 111 athletes for VA +/− RA and we found MF consistent with myocarditis in 18 (16%) of them. Only 2/18 referred past febrile status probably correlated with myocarditis and 1 had symptoms consistent with acute myocarditis. Number of VA was not correlated with MF fibrosis, while polymorphic VA and exercise-correlated VA were the most frequent finding. 5/18 (28%) had also rest and/or exercise induced RA. 10/18 (55%) athletes underwent electrophysiological study without any induction of arrhythmias. 7/18 (39%) underwent also electroanatomical mapping (EAM) with pathological findings in 5/7 (71%). All of these 5 underwent endomyocardial biopsy guided by EAM and in 2 cases bioptic findings were consistent with arrhythmogenic cardyomyopahty (ACM). All 18 athletes were disqualified from competitive sport as for Italian Sport Medicine protocols.

Conclusion

MF consistent with past myocarditis is a not infrequent finding in athletes with VA with or without RA. Morphology and exercise behavior of VA are the most important “alarm bell”, while VA number is not correlated with MRI pathological findings. Sometimes MF interpreted as consistent with past myocarditis is actually the manifestation of ACM. Identification of these diseases is of extreme importance for athletes' safety.
P4429Cardiac magnetic resonance characteristics of professional athletes and hypertrophic cardiomyopathy patients in the grey zone of hypertrophy
Authors: Czimbalmos C , Csecs I , Dohy Z , Toth A , Suhai F , Szabo L , Horvath V , Sydo N , Kiss O , Becker D , Merkely B , Vago H
Published: October 2019

Differentiation between athlete's heart and hypertrophic cardiomyopathy (HCM) may cause difficulties especially in patients in the grey zone of hypertrophy.

We aimed to determine conventional cardiac magnetic resonance (CMR) parameters such as left ventricular (LV) ejection fraction (EF), BSA-corrected end-diastolic (EDVi), end-systolic and stroke volume (SVi), mass (Mi), derived CMR parameters such as maximal end-diastolic wall thickness to LVEDVi ratio (EDWT/LVEDVi), LVM to LVEDV ratio (LVM/LVEDV), and CMR based strain values (global longitudinal (GLS), radial (GRS) and circumferential strain (GCS)) in male HCM patients and athletes.

We consecutively enrolled male HCM patients with only slightly elevated EDWT (13–18 mm) and highly trained healthy athletes (n=30, 18.7±1.2 training hrs/week) with marked LV hypertrophy. HCM patient group was divided into sedentary (n=30, <7 training hrs/week) and athletic HCM group (n=10; >7 h/week, 12.7±7.3 h training hrs/week).

Both sedentary and athletic HCM patients showed higher LVEF, lower LVEDVi and LVESVi and higher EDWT compared to the healthy athletes. LVMi of both healthy athletes and athletic HCM patients was significantly higher than in sedentary HCM patients, respectively (98.9±11.4; 94.5±7.8 vs 78.1±14.4 /m2). EDWT/LVEDVi ratio was higher in both sedentary and athletic HCM patients compared to healthy athletes, respectively (0.19±0.04; 0.17±0.04 vs 0.11±0.02). LVM/LVEDV also showed significant difference between HCM patients and healthy athletes. GLS and GRS showed no significant difference between the three groups, GCS was higher in athletic HCM compared to healthy athletes (−20.7±2.2 vs −17.8±2.3%).

Figure 1. Feature tracking analysis of a healthy athlete and a patient with HCM.

CMR characteristics of athletic and sedentary HCM may fundamentally alter. Our preliminary data suggest that besides conventional CMR parameters, derived parameters such as EDWT/LVEDVi and LVM/LVEDV ratios and deformation imaging may also help the differentiation between pathological and physiological hypertrophy.

Acknowledgement/Funding

National Research, Development and Innovation Office (NKFIH) of Hungary (K 120277). Project no. NVKP_16-1-2016-0017
P4431Cardiopulmonary exerscise stress tests vs standard exercise stress tests in the rational prescription of physical activity in men
Authors: Stuto A , Armaro B , Cosentino E , Canonico G , Ambu A , Raineri F , Lo Giudice A , Cascone G , Canonico S , Cassarisi S , Ierna S , Basile G
Published: October 2019

Background

The standard exercise stress test (ET) provides direct measurement of the load tolerated by the subject, but the cardiopulmonary exercise stress test (CPET) in addition to the measurement of the work load also provides direct measurement of the corresponding oxygen consumption.

Objective

The aim of the present study was to estimate the differences between the estimated oxygen consumption based on the load (ET) and the one directly measured with the CPET, and to highlight and quantify the inaccuracies of the indirect estimate of oxygen consumption and its consequences on the rational prescription of physical activity.

Material and method

The tests performed on 7544 males from January 2007 to October 2018 were analyzed. For each test the sustained load, the consumption of direct oxygen, and the estimated oxygen consumption based on the load sustained with the use of a formula provided by the American College of Sports Medicine and reported below:

VO2max (ml/kg/min) = (10.51 x Watt) + (6.35 x weight in kg) − (10.49 x Età) + 519.3.

The total population of the subjects examined was divided into two groups: Group A: 1358 subjects without signs of heart disease, and Group B: 6186 subjects with heart disease.

Results

In the total population the oxygen consumption (VO2) estimated on the basis of the load was overestimated in 22% of subjects, underestimated in 55% of subjects and overlapping in 23% of subjects. In Group B the calculated VO2 was overestimated in 38%, underestimated in 54% and overlapping in 8% of the subjects. In group A the calculated VO2 was overestimated in 33%, underestimated in 54% and overlapping in 9% of subjects.

Conclusions

In subjects with heart disease the VO2 calculated on the basis of the sustained load is overestimated or underestimated in 92% of subjects. The CPET through direct measurement of oxygen consumption provides a precise estimate of functional capacity, an essential prerequisite for a correct rational prescription of physical activity. Because of this peculiarity, the CPET is absolutely irreplaceable in cardiac patients in which a correct rational prescription of physical activity is crucial.
P4446Cardiopulmonary exercise test in young patients with in early stages of sarcoidosis
Authors: Bartosh-Zelenaya S Y U , Evsikova I A , Naiden T V , Mamaeva O P , Shcherbak S G
Published: October 2019

Purpose

To assess CPET data in young patients with pulmonary sarcoidosis (grade I-II) respectively corresponding parameters in healthy individuals.

Methods

99 people aged 25–44 years were examined: 66 people with pulmonary sarcoidosis (PS) I-II grade formed the main group. The control group included 33 healthy, non-smoking people. In both groups the CPET was performed for assessment functional status of cardiorespiratory system.

Results

Vital capacity and FEV1 didn't differ in both groups (p=0.6 and 0.19). However, Tiffno's index was significantly higher in the control group (p=0.0002). There were no differences in RVOT1, RVOT2, RA volume index in both groups. A comparative analysis of the RV wall thickness revealed that the values in both groups did not exceed the normal limits, but in the main group it was significantly larger (p=0.01). The basal RV diameter at rest were also larger in patients with sarcoidosis (p=0.007). LV contractility at rest was within normal values in both groups, however, in patients with sarcoidosis EF were statistically less than in the control group. At the peak of exercise EF increased more significantly in the control group (p<0.0001). The EF-2D increase was higher in healthy young's (15% vs 10%). GLS LV both at rest and at the peak of exercise in both groups had no statistically significant differences. RV GLS in patients with sarcoidosis at the peak of exercise didn't increase (p=0.18) in contrast to healthy individuals (p=0.002). PAP at rest in patients with sarcoidosis was slightly higher than in healthy individuals (p=0.03), but didn't exceed the standard values. At the peak of exercise, in the main group PAP increased more than in the control group (p=0.ehz745.084701). In the control group the upper quartile of PAP was 29 mm Hg, at the peak of exercise-38 mm Hg. In the main group these values were much higher: 35 and 62 mm Hg. In control group, the maximum OC was higher (27.07±3.53 ml/min/kg, p=0.014). The duration of exercise was longer in healthy individuals (p=0.04).

Thus, at the early stages of pulmonary sarcoidosis in young people there are no significant contractility abnormalities both at rest and at the peak of exercise, whereas the EF increase was lower than in healthy individuals. It is necessary to determine GLS RV, which may indicate RV dysfunction preceding the development of LV dysfunction. In patients with sarcoidosis, it's necessary to determine PAP at the peak of exercise, which increased in 79% of cases more than in healthy individuals. This may be due to secondary heart lesion at presence of pulmonary hypertension. The maximum oxygen consumption at the peak of exercise is higher in healthy individuals than in patients with sarcoidosis. So functional reserve was higher in the control group.

Thus, the CPET today is an informative diagnostic tool which should be included in the diagnostic algorithms for patients with sarcoidosis.
P4473Brain renin-angiotensin system blockade with firibastat, an orally active, central acting aminopeptidase A inhibitor prodrug prevents cardiac dysfunction after myocardial infarction in mice
Authors: Boitard-Joanne S , Marc Y , Keck M , Mougenot N , Agbulut O , Balavoine F , Llorens-Cortes C
Published: October 2019

Introduction

Brain renin-angiotensin system (RAS) hyperactivity has been implicated in sympathetic hyperactivity and progressive left ventricular (LV) dysfunction after myocardial infarction (MI). Brain angiotensin III, generated by aminopeptidase A (APA), is one of the main effector peptides of the brain RAS in the control of cardiac function.

Purpose

We hypothesized that orally administered firibastat (previously named RB150), an orally central acting APA inhibitor prodrug, would attenuate heart failure (HF) development after MI in mice, by blocking brain RAS hyperactivity.

Methods

Two days after MI induced by the left anterior descending artery ligation, adult male CD1 mice were randomized to three groups, for four to eight weeks of oral treatment with vehicle (MI+vehicle), firibastat (150 mg/kg; MI+firibastat) or the angiotensin I converting enzyme inhibitor enalapril (1 mg/kg; MI+enalapril) as a positive control.

Results

From one to four weeks post-MI, brain APA hyperactivity occurred, contributing to brain RAS hyperactivity. Firibastat treatment during four weeks after MI normalized brain APA hyperactivity, with a return to the control values measured in the sham group. Four and six weeks after MI, MI+firibastat mice had a significant lower LV end-diastolic pressure, LV end-systolic diameter and volume, and a higher LV ejection fraction than MI+vehicle mice. Moreover, the mRNA levels of biomarkers of HF (Myh7, Bnp and Anf) were significantly lower following firibastat treatment. For a similar infarct size, the peri-infarct area of MI+firibastat mice displayed lower levels of mRNA for markers of fibrosis such Ctgf and collagen types I and III than MI+vehicle mice.

Conclusions

Chronic oral firibastat administration after MI in mice normalizes brain APA hyperactivity, thereby normalizing brain RAS hyperactivity, whilst preventing cardiac dysfunction and attenuating cardiac hypertrophy and fibrosis.

Acknowledgement/Funding

INSERM, College de France, ANR LabCom, and Quantum Genomics
P4495Dimethylguanidino valerate a lifestyle related metabolite associated with future coronary artery disease and cardiovascular mortality
Authors: Ottosson F , Ericson U , Almgren P , Smith E , Brunkwall L , Hellstrand S , Nilsson P M , Orho-Melander M , Melander O
Published: October 2019

Background

Identification of lifestyle modifiable metabolic pathways related to cardiometabolic disease risk is essential for improvement of primary prevention in susceptible individuals. It was recently shown that plasma dimethylguanidino valerate (DMGV) levels are associated with incident type 2 diabetes (T2DM). Our aims were to investigate if plasma DMGV is related to risk of future coronary artery disease (CAD) and with cardiovascular mortality and to replicate the association with T2DM and to pinpoint candidate lifestyle interventions susceptible to modulate DMGV levels.

Methods

Plasma DMGV levels were measured using liquid chromatography-mass spectrometry (LC-MS) in a total of 5768 participants from the Malmö Diet and Cancer Study – Cardiovascular Cohort (MDC), the Malmö Preventive Project (MPP) and the Malmö Offspring Study (MOS). Dietary intake assessment was performed in MOS.

Results

Baseline levels of DMGV associated with incident CAD in both MDC (HR=1.29, C.I= 1.16–1.43, P=3.3e-6) and MPP (OR=1.25, C.I=1.08–1.44, P=2.4e-3). In MDC, DMGV was associated with cardiovascular mortality and incident CAD, independently of traditional risk factors. Furthermore, the association between DMGV and incident T2DM was replicated in both MDC (HR=1.83, C.I=1.63–2.05, P=8.7e-25) and MPP (OR=1.65, C.I=1.38–1.98, P=8.7e-8). Intake of sugar-sweetened beverages (SSB) associated with increased levels of DMGV, while intake of vegetables and level of physical activity associated with lower DMGV.

Conclusions

We discovered novel independent associations between plasma DMGV and incident CAD and cardiovascular mortality, while replicating the previously reported association with incident T2DM. Additionally, strong associations with SSB, vegetable intake and physical activity suggest the potential to modify DMGV levels using lifestyle interventions.

Acknowledgement/Funding

Knut and Alice Wallenberg Foundation, Göran Gustafsson Foundation, the Swedish Heart- and Lung Foundation, the Swedish Research Council
P4502Noninvasively assessed mitochondrial function estimated by skin fluorescence is abnormal in coronary artery disease
Authors: Rechcinski T , Cieslik-Guerra U , Siedlecki P , Trzos E , Wierzbowska-Drabik K , Szymczyk E , Wejner-Mik P , Kurpesa M , Lipiec P , Kasprzak J D
Published: October 2019

Mitochondrial NADH undergoes oxygenation to NAD+ and NADH molecules, activated by ultraviolet light, start to emit fluorescence at a wavelength 460nm. This phenomenon can be measured to non-invasively assess mitochondrial function in the forearm epidermis at rest, during transient ischaemia, and afterward reperfusion assuming that it reflects abnormal microvascular circulation. We hypothesized that flow-dependent skin fluorescence (FDSF) is abnormal in patients with coronary atherosclerosis.

Methods

Prototype device manufactured by Angionica (Poland) was used to quantify FDSF recorded in forearm before, during and after 100 s of brachial artery occlusion in 63 individuals (26 with coronary artery disease (CAD) and 37 healthy volunteers. The absolute value of baseline FDSF (BASE), maximum FDSF (MAX), minimal FDSF (MIN), percentage ischemic response (IR) and hyperemic response (HR) were measured. Age, lipid profile, fasting glucose, HbA1c, C-reactive protein (CRP), systolic and diastolic blood pressure, pulse wave velocity (PWV), augmentation index, time domain heart rate variability parameters (SDNN, rMSSD) and estimated apnea/hypopnea index -eAHI (Holter ECG based), BMI, intima-media thickness (IMT), left ventricle systolic and diastolic function were determined in all study participants to search for potential correlations with FDSF.

Results

Measurements were feasible in all study subjects and examination duration was 9±1min. Hyperemic response (HR) was significantly lower in patients with CAD vs controls: 10,4 vs. 14,36 vs 14,73 – p=0,025. Other parameters: BASE, MAX, MIN, and IR were not significantly different between groups (p>0,05).

In the entire group, HR was correlated with age (r=−0,23 p=0,037), and with total or LDL cholesterol (r=0,37 p=0,001 and r=0,36 p=0,001). Interestingly, HR was also positively correlated with SDNN (r=0,26 p=0,044) and rMSSD (r=0,29 p=0,026).

Mode of FDSF examination

Conclusion

Abnormal mitochondrial function probably secondary to microcirculatory disorder is detectable by noninvasive skin fluorescence test as decreased hyperemic response in patients with coronary disease. Age and cholesterol concentration as well as autonomic balance Holter indices are correlated with hyperemic response.

Acknowledgement/Funding

POIR.01.01.01.0540/15-00
P4503A multi-site coronary vein sampling study on cardiac troponin T degradation in non-ST-elevation myocardial infarction
Authors: Cramer G E , Damen S A J , Vroemen W H M , Mezger S T P , Suryapranata H , Van Royen N , Bekers O , Meex S J R , Wodzig W K W H , Verheugt F W A , De Boer D , Brouwer M A , Mingels A M A
Published: October 2019

Background

High-sensitivity cardiac troponin (hs-cTn) assays have reduced specificity for myocardial infarction (MI). In conditions other than MI, cardiac troponin T (cTnT) elevations have been attributed to small cTnT fragments. In search of improved cTnT assay specificity for MI, determination of the in-vivo molecular appearance of cTnT during MI is pivotal.

Purpose

To determine cTnT composition close to its site of release and during the course of MI by multi-site coronary venous system (CVS) and peripheral sampling.

Methods

Lithium-heparinized (LH) plasma and serum samples were obtained from multiple CVS locations in NSTEMI patients. Additionally, samples were drawn from a peripheral artery and vein followed by collections at 6- and 12 hours post-catheterization. cTnT concentrations were measured using the hs-cTnT immunoassay (Roche). The molecular cTnT composition was determined by gel filtration chromatography and Western blotting in an early and late presenting patient.

Results

CVS hs-cTnT concentrations were 28% higher than in the peripheral artery sample (n=71, p<0.001). In contrast to LH plasma, serum caused pre-analytical cTn T-I-C complex disintegration and cTnT degradation. CVS samples demonstrated presence of cTn T-I-C complex, free intact cTnT, and 29 kDa and 15–18 kDa cTnT fragments in higher absolute concentrations than measured peripherally. While the proportion of cTn T-I-C complex decreased and disappeared over time, 15–18 kDa cTnT fragments increased. Moreover, cTn T-I-C complex was more prominent in the early versus the late presenting patient.

Central illustration

Conclusions

In NSTEMI, cTnT is released as a combination of cTn T-I-C complex, free intact cTnT and multiple cTnT fragments. Over time, the composition of observed cTnT forms changes due to in-vivo degradation. These findings serve as a stepping stone to improve diagnostic accuracy of the hs-cTnT assay for MI.
P4508Uncoupling of right ventricular and arterial elastance in advanced HFrEF predicts poor survival
Authors: Melenovsky V , Tupy M , Solar N , Al-Hiti H , Reichenbach A , Havlenova T , Monzo L , Netuka I , Kautzner J
Published: October 2019

Background

Right ventricular dysfunction (RVD) in heart failure (HF) is poorely understood and difficult to recognize due to complex RV geometry and load-dependency. Pressure volume analysis using SPECT ventriculography combined with right heart catheterisation (RHC) ar rest and during load-altering maneuver (7 min 60° leg rise, LR) can improve detection of RVD.

Methods

Advanced HF patients underwent RHC with thermodilution CO measurement (Corodyne, Braun, Germany) followed by gated 3D equilibrium Tc-labeled blood pool SPECT ventriculography (D-SPECT, Israel). QBS software was used to calculate chamber volumes to derive contractility (EF, elastance: Ees) and afterload (Ea). Patients were followed for occurence of death without Tx, urgent Tx or VAD implant.

Results

From 157 patients (age 55±12 years, LV EF 22±12%, 86% males), 83% had PH (mPA>25 mmHg) and 58% had RVD (RV EF <35%). Despite afterload (PAm, Ea) correlated with RV function (RVEF, RV Ees), it explained <10% of its variance; at rest or during LR. Leg rise led to significant (p<0.01) increases of RVEDP, PAWP, mPA (+2, +3, +4 mmHg), to increases of RVEDV, RVESV (+18 and +9 ml), but to reductions of LVEDV and LVESV (−14 and −9 ml) and to no change of RV or LV EF, CO, HR. LR inreased RV afterload (Ea), had no change on RV contractility but it further reduced RV-PA coupling (Ees/Ea). With LR, 70% of patients had relative increase in RV diastolic volume compared to LV (REDV/LVEDV ratio), reflecting RV diastolic reserve. After median of 112 (IQR: 33–229) days, 73 pts (46%) had an event (urgent Tx, VAD or death). In Cox analysis, both RVD and PH were associated with adverse outcome. From all volume- and pressure-derived measures acquired at rest and during LR, low resting RV coupling ratio (Ees/Ea) had strongest association with events (Z-standartized RR 0.4, 95% CI: 0.2–0.6, p<0.0001). Patients with larger relative increase in RV volume during LR (larger RV diastolic reserve) had better outcome.

Conclusion

Pressure-volume analysis of RV function provides more precise characterization of RV-PA coupling and allows better event-free survival prediction than isolated volumetric or hemodynamic indexes. Low resting RV Ees/Ea ratio (< median 0.324) predicts particularly poor survival.

Acknowledgement/Funding

Ministry of Health of the Czech republic, grant AZV 17-28784A
P4518Cerebral blood flow is lower in heart failure patients with reduced ejection fraction
Authors: Babayigit E , Cavusoglu Y , Dural M , Mert K U , Ulus T , Gorenek B
Published: October 2019

Purpose

Heart and brain interaction is a well-known entity in heart failure (HF) and left ventricular systolic dysfunction poses an increased risk for stroke and cognitive impairment. Transcranial Doppler (TCD) provides valuable information on cerebral blood flow and detects microembolic signals that can be used to determine the risk of cerebrovascular events. However, less is known about cerebral blood flow in HF patients with reduced EF. So, we aimed to evaluate cerebral blood flow rates by means of TCD in HF patients with reduced ejection fraction (EF).

Methods

This study included 46 HF patients with an EF less than 35% (mean age 65.2±11 years, mean EF 20.1±3.8%) who underwent to TCD examination. In addition, 26 healthy individuals with sinus rhythm and EF >50% (mean age 64.4±9.0 years, mean EF 63.5±2.38%) were included in the study as a control group. Minimum, maximum and mean flow velocities of the both right middle cerebral artery (RMCA) and left middle cerebral artery (LMCA) determined by TCD were analyzed.

Results

The average of RMCA maximum and mean flow velocities were found to be significantly lower in HF patients than those in control group (76,06±23,7 cm/s and 48,49±16,4 cm/s in HF group vs 87,84±14,5 cm/s and 56,41±10,7 cm/s in control group, p=0,025 and p=0,016, respectively). The average of LMCA maximum and mean flow velocities were also significantly lower in HF patients than those in control group (75,1±22,3 cm/s and 47,57±14.8 cm/s in HF group vs 88,73±17,7 cm/s and 57,15±12,4 cm/s in control group, p=0,009 and p=0,007, respectively). However, there was no significant difference in minimum RMCA or LMCA flow velocities between HF group and control groups (33,5±10,6 cm/s and 32,86±9,58 cm/s in HF group vs 36,34±9,2 cm/s and 36,53±10,4 cm/s in control group, p=0,226 and p=0,157, respectively). No significant microembolic signals were detected in HF and control groups.

Conclusions

The results of this study showed that HF patients with reduced EF have lower cerebral blood flow velocities as compared to healthy controls, which might be one of the explanations of the adverse interaction between heart and brain in HF.
P4519Sleep Apnea screening in Heart Failure: an exploratory analysis
Authors: Gomes R M , Rocha M L , Cunha G J , Morais R M , Duarte J D , Araujo I , Fonseca M C
Published: October 2019

Background

Sleep Apnea (SA) is increasingly recognized in patients (pts) with Heart Failure (HF). Nocturnal polysomnography (PSG) is the gold-standard to diagnose SA. Currently, portable devices have been thoroughly validated in HF cohorts.

Purpose

To determine the correlation between clinical, laboratory and respiratory measurements with the presence of SA (defined as apnea-hypopnea index (AHI) >15/h) and desaturation time with SpO2 <90% (T90) ≥22 minutes, a strong mortality predictor in HF with reduced ejection fraction (HFrEF); and to compare the features of pts with HFrEF vs HF with preserved ejection fraction (HFpEF).

Methods

Our work is based on a single-center retrospective cohort of pts hospitalized for decompensated HF during 2013–2018. All pts were screened for SA with ApneaLinkTM after compensation the night preceding discharge. HF was defined as recommended by the European Society of Cardiology guidelines. A left ventricular ejection fraction ≤45% and >45% was used to define HFrEF and HFpEF, respectively, as per SERVE-HF trial.

Results

A total of 228 pts were included in the analysis (mean age 75.3±10.5 years, 48.9% male). SA was present in 135 (59.2%) pts and 41.2% had HFrEF. Mean AHI was 24.5±19.2/h, mean O2 desaturation index (ODI) was 24.4±21.0/h and mean T90 was 169.6±151.2 minutes. In multivariate models, ODI, gender and ischemic HF were predictors of AHI >15/h (R2 65.8%), with ODI being the strongest predictor (standardized coefficient 64.8%). Similarly, mean SpO2 was the only predictor of T90 ≥22minutes (R2 65.8%) (Figure 1). HFrEF pts had more often AHI>15/h (73.4% vs 48.5%, p<0.001), more total apneas (62±148 vs 16±79, p<0.001), obstructive apneas (28±76 vs 8±43, p<0.001) and central apneas (6±20 vs 0±5, p<0.001) than those with HFpEF. In multivariate models, ODI (OR 1.14, CI 1.03–1.26, p=0.013 for HFrEF; OR 1.21, CI 1.11–1.33, p<0.0001 for HFpEF) and mean SpO2 (OR 0.29, CI 0.14–0.60, p=0.001 for HFrEF; OR 0.23, CI 0.10–0.52, p<0.0001 for HFpEF) were the only predictors of AHI >15/h and T90 ≥22 minutes in both groups, respectively.

Conclusions

SA was highly prevalent in HFrEF and HFpEF. ODI and mean SpO2 were highly predictive of AHI >15/h and T90 ≥22minutes, respectively, both prognostic markers validated in a population with HFrEF, and equally so in HFrEF and HFpEF. These findings hypothesize a similar pathophysiology of SA in HF, regardless of left ventricular systolic function. Also, whether simple pulse oximetry can be routinely used for SA screening, since PSG and portable devices are often not widely available, is a finding worth being prospectively assessed.

Acknowledgement/Funding

None