bluuebunny/crossref_metadata_2025 huggingface dataset:
P3407Genetic predisposition and QRISK3 algorithm are promising cardiovascular risk scoring tools in young patients with axial spondyloarthritis (Bechterew's disease)
Authors: Vasilenko E , Dadalova A , Nikolaeva O , Korolev M , Mazurov V , Gaydukova I
Published: October 2019

Introduction

Major cardiovascular events (CVE) are frequently registered in patients with axial spondyloarthritis (axSpA) at age 35–55 years old. However, assessment of cardiovascular risk (CVR) in these age is complicated, as in pts <40 years conventional CVR scales (SCORE, ets.) are not recommended.

Aim of the study

To show capability of QRISK3 in assessment of CVR in young pts with axSpA and its association with gene polymorphisms, responsible for the inflammation and neoangiogenesis.

Materials and methods

The study included 46 pts 25–40 years old with axSpA (ASAS criteria 2009), achieved inactive disease on TNF-α inhibitors. AxSpA activity was assessed with ASDAS and BASDAI, CVR with QRISK3 (https://qrisk.org/three/). Gene polymorphisms to cytokines, responsible for inflammation and neoangiogenesis were measured (IL17A-197, IL17F7 His/Arg, IL17F-11139 c/g, TNF-863, TNF-308, TNF-238, IL1B-31, IL4–590, IL6–174, IL10–1082, IL10–592, VEGF-2578, VEGF936, MMP2–1306, MMP3–5A6A, and MMP9–1562).

Results

Mean age of axSpA pts was 32.5±3.87 years, 36 (78.3%) pts were male, axSpA duration 8.71±4.72 years, duration of the treatment 3.1±2.4 years, ASDAS 1.95±1.23, BASDAI 1.4±0.8, QRISK3 score 1.18±1.64%. 34 (75.6%) of the pts had a low CVR and 11 (23.9%) had increased CVR. All the patients with increased CVR had strong associations with some alleles of TNFα, IL17F and IL6, p<0.ehz745.0282 for all the correlations (table 1).

Interrelations of CVR with another gene polymorphisms were not significant (R<0.25, p≥0.05, data are not present).

Coefficient of correlation of QRISK3 and Gene polymorphisms (results of exploratory factor analysis with “varimax” rotation) QRISK3 IL17F-11139 CC IL17F-11139 CG IL17F7 His/His IL17F7 His/Arg IL6–174 CC IL6–174 CG TNF-308 GA TNF-308 GG 0.486 0.830 −0.830 −0.824 0.809 −0.564 0.545 0.935 −0.935

Conclusion

A quarter of axSpA pts in age <40 years have an increased CVR. Similar gene polymorphisms in IL-6, IL17F, and TNF-α are strongly associated with increased CVR. QRISK3 and gene polymorphisms could be promising tools in CVR assessment in axSpA, acceptable in any age.

Conflict of interests

Not declared.
P3415Will less developed countries be capable of giving high-quality universal coverage to cardiovascular disease survivors? Results from a national health survey, Chile ENS 2016–2017
Authors: Margozzini P , Passi A , Kruk M , Danaei G
Published: October 2019

Background

Chilean Health System has fully implemented Universal Health Coverage (UHC) for acute cardiovascular events since 2005. Age-adjusted cardiovascular mortality has decreased, but there is limited information about coverage and quality of chronic health care given to cardiovascular disease (CVD) survivors at the national level.

Purpose

To assess the prevalence and quality of care in Chilean adult CVD survivors.

Methods

Chilean National Health Survey 2016–2017 (ENS 2016–2017) is a random stratified multistage sample of non-institutionalized population over 14 years (n=6240). Age, education, gender, rural/urban and geographical area weighted prevalence of CVD survivors (self-reported medical diagnosis of myocardial infarction or cerebrovascular attack) were calculated. High quality of care was defined as meeting six criteria simultaneously: under 70mg% LDL- C level, statin use, aspirin use, blood pressure under 130/80 mmHg, HgA1C<7 or 8 (>74-year-old) and non-smoking. Quality of care was explored using multivariate linear and logistic regression adjusting by age, gender, education and year of diagnosis (before or after UHC).

Results

Weighted national prevalence of CVD survivors in over 20-year-old population was 6.1%. The sample size for the CVD survivor analyses was n=455. 28.7% of CVS had their first event before the year 2005 (n=141). Overall 27.9% had LDL-C under 70mg%, 37.8% used statins, 41.4% used aspirin, 37.8% had controlled blood pressure, 78.3% were non-smokers and 84.3% had good glycemic control. National “high quality of care” prevalence in CVD survivors was 0.3%, 0.4% and 0.1% for men and women respectively. LDL and Blood pressure control prevalence (meet both criteria simultaneously) was 4,4%. In the adjusted multivariate model age was associated to a higher number of quality criteria achievement.

Conclusion

The number of CVD survivors in Chile is a huge challenge for the health care system. Universal coverage does not guarantee the quality of chronic life long care. Specific surveillance in high-risk population is needed to assess the system's effectiveness and accountability.

Acknowledgement/Funding

ENS 2016-2017 was funded by the chilean Ministry of Health (MINSAL)
P3426Machine learning for medical decision support in a first attendance ambulatory of a tertiary care cardiologic hospital
Authors: Hortegal R , Babolin B , Hsu G J , Polivanov R , Salvador P , Brito S , Santos I , Regis C D , Fragata A , Szewierenko P
Published: October 2019

Introduction

Cardiovascular disease is an expensive public health problem. Establish the right level of healthcare attention for each patient in a high-demand system is a complex task, and in this scenario, the development of computational methods to support medical decisions has shown to be quite promising.

Purpose

Define Machine Learning (ML) algorithms to support medical decisions in a first attendance ambulatory of a tertiary cardiology hospital.

Methods

A prospective observational study was performed in 336 patients (58±13 years and 49.4% male), obtaining clinical and ECG/VCG data. A follow up of 15 months was performed in order to access MACE, PCI, Cardiac Surgery and evidence of Severe Cardiac Disease. From twenty-five initial features, running the ML K-means Clustering algorithm, we identify which ones to use and the optimal number of Clusters. Once defined the Clusters the data were labeled, and then the clusters compared with field data (outcomes) and by Kaplan Meyer curves. The labeled data were also run by a Gradient Boosting algorithm in order to define a Predictor for future use in medical decision support.

Results

The best result, with well-defined Clusters, was obtained with the combination 5 Clusters and 8 specific Features, and the follow-up data has matched the Cluster classification as shown in the Table. Kaplan Meyer curves corroborated these finding with statistically significant differences between the Clusters: Log-rank test (p<0.001). Predictor algorithm, trained by the labeled data, presented an average precision of 95% (CI 95%; 91–100%).

Clustering Outcomes vs Follow-up results Cluster Patients Features Follow-up 15 months results Age BMI Previous Cardiac Previous Previous Diabetes** SM QRS_T QRS_T_loop Severe Heart Outcome (year)* (kg/m2)* Surgery** MI** PCI** angle* index* Disease* (%) 1 96 46±12 28.3±5.4 0 0.03 0.02 0 60±34 0.31±0.61 0.26 4.2% 2 60 61±12 29.6±5.5 0 0.25 0 1 97±45 0.41±1.32 0.57 20.0% 3 34 64±11 27.6±3.8 1 0.59 0.35 0.5 118±43 -0.11±1.22 0.72 35.3% 4 114 64±9 25.4±4.0 0 0.21 0 0 101±41 0.48±0.98 0.38 12.3% 5 32 50±10 28.7±5.1 0 0.88 1 0.47 82±34 0.52±0.69 0.81 50.0% *Mean ± sd; **yes = 1; no = 0.

Conclusion

The defined Predictor, using eight simple, quick and easy to get Features (clinical and ECG/VCG), shows excellent performance to classify patients who require tertiary cardiovascular healthcare attention.
P3446Left-ventricular assist device as a destination therapy in Duchenne cardiomyopathy: are we ready to change the natural history?
Authors: Adorisio R , D'Amario D , Cantarutti N , Cicenia M , D'Amico A , Baban A , Bertini E , Catteruccia M , Perri G , Filippelli S , Drago F , Amodeo A
Published: October 2019

Background

Heart failure is becoming the most prominent cause of death among patients with Duchenne Muscular Dystrophy (DMD) and end-stage cardiomyopathy (CMP). Implantation of left ventricular assist devices (LVAD) as destination therapy (DT) in this group of patients is still matter of debate. No current data are available on long-term follow- up of young patients.

Purpose

The aim of this study was to evaluate the long-term outcome of LVAD in DMD end stage heart failure (HF) compared to a group treated optimal medical treatment (OMT) with inotropes

Methods

All patients affected by DMD patients presenting with end-stage HF receiving OMT or LVAD have been reviewed. All data about characteristics of HF at presentation including assessment of nutritional status and respiratory function, left ventricular ejection fraction, brain natriuretic peptide, serum sodium, in-hospital treatment and long term follow up have been collected. OMT group was constituted by 4 patients matching implantation VAD criteria but not eligible or refusing treatment. Survival was represented by Kaplan Meier analysis.

Results

A total of 12 DMD patients with end-stage CMP were considered for this analysis. 8 have been implanted with LVAD during the period from 2011 until mid-2017 and compared with 4 treated with OMT. Mean systolic pressure was 103 versus 91 mmHg in those not receiving LVAD (p=0.2), and left ventricular ejection fraction at the time of presentation was 16‰ for LVAD group and 22‰ for the second group (p=0.1). LVADs improved survival throughout follow-up for patients undergoing baseline inotropic infusions (P=0.0014); for the LVAD group versus the OMT group, 1-month survival was 100‰ and 67‰ respectively and 2-month survival was 100‰ versus 0‰. For LVAD group survival was 86‰ at one year, 71‰ at 2 years and 48‰ at 5 years from implantation. Analysis on short and long-term follow-up showed significant improvement of survival in DMD patients treated with LVAD (log rank<0.001), with a 5-year increase in life expectancy.

Conclusions

LVAD improved outcomes in patients with LVAD when compared to those without. Long-term follow-up was similar to DT LVAD adult population. Further studies are necessary to confirm these data.
P3475Dabigatran inhibits the activation of endothelial progenitor cells induced by thrombin
Authors: Papadaki S , Sidiropoulou S , Moschonas I , Tselepis A
Published: October 2019

Introduction

Thrombin is a coagulation serine protease, which also activates various cell types, including endothelial cells. Late-outgrowth endothelial cells (OECs) are a type of endothelial progenitor cells that contribute to endothelial regeneration and angiogenesis. Dabigatran is a direct oral anticoagulant that inhibits thrombin's action and is widely used in everyday clinical practice.

Purpose

We investigated the effect of dabigatran on thrombin-induced activation of OECs, using the membrane expression of adhesion molecule ICAM-1 as activation marker. Control experiments were conducted in mature human umbilical vein endothelial cells (HUVECs).

Methods

CD34+ cells were isolated from cord blood mononuclear cells, using human CD34 Microbead Kit and appropriately cultured for OEC formation. HUVECs were purchased from Lonza. Confluent OECs and HUVECs were incubated with 10 or 20 μM dabigatran for 10 min, before activation with 8 U/mL thrombin, for 24 h. The effect of dabigatran on ICAM-1 expression (anti-CD54-PE) was evaluated in both cell types as % gated CD31+/CD54+ cells, using flow cytometry.

Results

Thrombin induced ICAM-1 membrane expression by 33±15% on OECs and by 123±22% on HUVECs, compared with respective untreated cells (p<0.05 for both comparisons, from 6 different experiments). Dabigatran at 10 μM significantly inhibited ICAM-1 expression by 36±7% on OECs and 57±8% on HUVECs, as well as at 20 μM by 51±8% on OECs and 79±7% on HUVECs (p<0.05 for all comparisons, from 4 different experiments).

Conclusions

We show for the first time that dabigatran at concentrations relevant to those existing in vivo after oral administration, inhibits the thrombin-induced membrane expression of the adhesion molecule ICAM-1 on OECs, a phenomenon that is also observed on mature endothelial cells. The significance of this effect regarding the pathophysiological role of OECs and mature endothelial cells at the clinical level remains to be established.

Acknowledgement/Funding

Operational Program “Human Resources Development, Education and Lifelong Learning”. Co-financed by the European Union and Greek national funds
P3492Carvedilol and its analogue VK-II-86 attenuate stretch-induced manifestations of mechanoelectric feedback
Authors: Del Canto Serrano I , Santamaria L , Genoves P , Such-Miquel L , Zarzoso M , Parra G , Arias-Mutis O , Such L , Alberola A M , Soler C , Chorro F J
Published: October 2019

Background

Mechanical stretch modifies Ca2+ handling and myocardial electrophysiology, favoring arrhythmogenesis. The store-overload-induced Ca2+ release (SOICR) through the ryanodine receptor (RyR2) seems to be implicated in this deleterious effect. Carvedilol and its analogue VK-II-86 (which does not have significant beta-blocking effects) suppress SOCIR by directly reducing the open duration of the cardiac RyR2, and could modulate calcium-related changes produced by myocardial stretch.

Purpose

The aim of this study was to investigate, by the ventricular fibrillation (VF) spectral analysis, whether carvedilol and VK-II-86 prevents stretch-induced arrhythmogenic effects.

Methods

The VF modifications induced by acute stretch were studied in Langendorff-perfused rabbit hearts using epicardial multiple electrodes under control conditions (n=10), during carvedilol infusion (0.1 and 1 μM) (n=10) and during VK-II-86 infusion (0.1 and 1 μM) (n=10). Spectral techniques were used to establish the baseline and stretch characteristics in the three series above mentioned: VF dominant frequency (DF) and VF spectral concentration (SpC) were determined. A two-factor ANOVA test was used and significance was reached when p<0.05.

Results

Myocardial stretch significantly increased DF with respect to pre-stretch values in control conditions (13.3±1.2 vs. 16.1±3.0 Hz, p<0.05) and during the perfusion of 0.1μM carvedilol (11.6±1.5 vs. 13.6±2.9 Hz, p<0.05) and 0.1μM VK-II-86 (13.2±2.2 vs. 16.2±4.1 Hz, p<0.05). However, the maximum concentration of both drugs (1μM) abolished this stretch-induced VF acceleration (carvedilol: 6.9±2.2 vs. 7.3±2.6 Hz, ns; VK-II-86: 7.0±1.4 vs. 7.1±0.6 Hz, ns). The significant stretch-induced decrease in SpC in control conditions (31.4±8.6 vs. 23.2±6.4%, p<0.01) was attenuated under 0.1μM carvedilol (0.1μM: 27.6±8.4 vs. 23.5±6.1%, ns) and 0.1μM VK-II-86 (24.7±5.4 vs. 21.2±3.9%, ns), but not under 1μM of both drugs (carvedilol: 41.3±11.3 vs. 30.3±5.7%, p<0.05; VK-II-86: 34.7±7.2 vs. 28.3±3.9%, p<0.01). Nevertheless, during stretch, arrhythmia regularity and organization was greater (higher SpC) under the highest concentration of carvedilol (p<0.01) and VK-II-86 (p<0.05) than in control conditions (control: 23.2±6.4%, carvedilol 1μM: 30.3±5.7%, VK-II-86 1μM: 28.3±3.9%).

Conclusion

Carvedilol and its analogue VK-II-86 abolished the changes in VF activation frequency produced by myocardial stretch at the highest studied concentration, and also attenuated the stretch-induced activation heterogeneity at the lowest concentration. The similarity in the effects of both drugs on the stretch-induced alterations would imply that its protective effect is due to its ability to inhibit store-overload-induced calcium release.
P3499Myocardial extracellular matrix during post-infarction remodeling: The role of C3-complement system
Authors: Garcia-Arguinzonis M , Vilahur G , Juan-Babot O , Diaz-Riera E , Badimon L , Padro T
Published: October 2019

Background

Healing of the myocardium or progression to heart failure following myocardial infarction (MI) seems directly related to dynamic changes in protein composition of the extracellular matrix (ECM). The myocardial matrisome, fraction of functional non-structural ECM-associated proteins (ECMm), may regulate myocardial remodeling post-MI but the mechanisms involved remain unknown. We identified the C3-complement system (C3-CS), a central effector pathway of the innate immune system, and cleavage products by proteomic analysis of porcine myocardial tissue post-MI. Here we investigated the C3-CS dynamic changes in the myocardial ECMm of reperfused hearts in relation to the ischemic zone and time of evolution post-MI.

Methods

ECMm proteins were investigated in the ischemic (ISCH) and non-ischemic (NISCH) zones in the porcine myocardium Post-MI. MI was induced by closed-chest balloon occlusion of the LAD for 90 minutes. Myocardial tissue was obtained after 2.5h, 1d, 3d and 30d after MI ((n=7/time-point). ECMm was extracted and C3-CS protein signature analyzed by western blot with specific antibodies. Myocardial tissue from the same areas was characterized by immunohistochemistry (IH).

Results

C3-cleavage products derived from activated C3-CS and its regulatory proteins (CFD, CFH, and CFHR5) were consistently detected in post-MI myocardium with a differential protein-signature between ISCH and NISCH zones and changed dynamically with elapsed time post-MI. The major changes were detected in the ISCH zone that was enriched with innate immunity cells (neutrophils and macrophages) as seen at day 3 by IH, suggesting local rather than systemic induction of C3-activation. Thus, CFD (C3-activating factor) and CFHR5 (C5-convertase inhibitor) were significantly increased in ISCH (>2fold vs. NISCH) at day 1, resulting in a high generation of the chemotactic and inflammatory C3a-product. At day 3, there was a high content of macrophages (>5fold higher than 24h) in the ISCH zone with enrichment of iC3b-products (p<0.05 vs. NISCH zone) derived from CFI/CFH-induced cleavage of C3b. In contrast, at day 30, there was enrichment in fibroblasts and collagen fibers in the ISCH zone and an increased C5-activation pattern compared to all the earlier times (2.5–24 h) and the NISCH zone. Thus, C5b, main source of the called “membrane attack complex” was significantly elevated and CFHR5 reduced compared to values at day 3.

Conclusion

Our results evidenced a time-dependant coordinated response of the C3-System in the ECMm of the ischemic myocardium, starting shortly after reperfusion and maintained up to 30 days that parallels changes in the cell pattern present in the ISCH zone. Our results show that C3-CS is associated to key cell functions for tissue remodeling and repair.

Acknowledgement/Funding

FIS PI16/01915 - Institute of Health Carlos III-ISCIII
P3511Gender differences in electrocardiographic risk markers of heart failure
Authors: Haukilahti M A E , Kentta T V , Tikkanen J , Anttonen O , Aro A , Kerola T , Rissanen H , Knekt P , Junttila M J , Huikuri H V
Published: October 2019

Background

Heart failure (HF) is one the leading causes of hospitalization in the Western world. Women have a lower rate of HF hospitalization and mortality compared to men. Role of 12-lead electrocardiography (ECG) as a risk marker of future HF in women is not well known.

Purpose

We studied the association of standard 12-lead ECG and clinical risk factors to HF hospitalization in women and in men separately from a large middle aged general population sample with a long-term follow-up.

Methods

Standard 12-lead ECG markers were analyzed from 10,864 subjects (48.8% women, N=5,215) of the prospective Mobile Clinic Study, and their predictive value for HF hospitalization was analyzed.

Results

During the follow-up (29.6±11.2 yrs.), a total of 1,743 subjects had HF hospitalization; out of these, 861 were women (49.4%). Several baseline characteristics, such as age, body mass index, blood pressure, and history of prior cardiac disease predicted the occurrence of HF both in women and men (P<0.001 for all). After adjusting for baseline variables, ECG sign of left ventricular hypertrophy (LVH) (P<0.001), and atrial fibrillation (P<0.001) were the only baseline ECG variables that predicted the future HF in women. In men, HF was predicted by fast heart rate (P=0.008), T wave inversions (P<0.001), abnormal Q waves (P=0.002), and atrial fibrillation (P<0.001). Statistically significant gender interactions in prediction of HF were observed in ECG sign of LVH (P<0.001), inferolateral T wave inversions (P=0.005), and heart rate (P=0.012).

Conclusions

ECG sign of LVH predicts future HF in middle-aged women independently, and T wave inversions and elevated heart rate are associated with HF hospitalization in men in.

Acknowledgement/Funding

Finnish Cultural Foundation, The University of Oulu Scholarship Foundation, Juho Vainio Foundation
P3515Gender differences in plasma levels and prognostic value of NT-proBNP in chronic heart failure
Authors: Aimo A , Januzzi J , Vergaro G , Latini R , Anand I S , Cohn J N , Gravning J , Brunner-La Rocca H P , Bayes-Genis A , De Boer R A , Takeishi Y , Eggers K M , Huber K , Passino C , Emdin M
Published: October 2019

Background

Natriuretic peptides are established biomarkers of heart failure (HF). The existence of gender-related differences in circulating levels and prognostic value are still controversial.

Methods

Individual patient data from studies assessing cardiac biomarkers (N-terminal fraction of pro-B-type natriuretic peptide - NT-proBNP - and high-sensitivity troponin T) for risk prediction in stable chronic HF were analysed.

Results

Women (n=1964, 23%) had higher median [interquartile interval] NT-proBNP concentrations than men (1678 [659–4215] vs. 1294 [522–2973] ng/L, p<0.001). Female gender predicted higher NT-proBNP independently from age, body mass index, glomerular filtration rate, left ventricular ejection fraction (LVEF), and atrial fibrillation.

Over a 2.4-year follow-up (1.6–3.2), 2351 patients (27%) died, and cardiovascular death occurred in 1558/8271 (19%). HF hospitalization was recorded in 2088/7944 (26%) over 2.0 years (1.3–2.6). Women and men had similar areas under the curve for the 3 endpoints, with higher cut-offs among women: all-cause death, 2328 ng/L vs. 1319 ng/L; cardiovascular death, 2328 ng/L vs. 1413 ng/L; HF hospitalization, 1265 ng/L vs. 907 ng/L. In the prognostic model above, the risk of the three endpoints increased by 32%, 35%, and 17%, respectively, per doubling of NT-proBNP in women, and by 41%, 45%, and 30% in men.

Conclusions

Women with chronic HF display higher NT-proBNP levels than men in the whole population as well as across many patient subgroups. This difference is not entirely explained by heterogeneity in age, BMI, or renal function. NT-proBNP holds independent prognostic significance in both genders, although alternative prognostic cut-offs might be considered for women.
P3517Failure to achieve adequate heart rate control in women during therapy optimization
Authors: Kutyifa V , Erath J W , Burch A , Assmus B , Bondermann D , Russo A M
Published: October 2019

Background

Previous studies highlighted the importance of adequate heart rate control in heart failure patients, and suggested under-treatment with beta-blockers especially in women. However, data on women achieving effective heart rate control during beta-blocker therapy optimization are lacking.

Methods

The wearable cardioverter defibrillator (WCD) allows continuous monitoring of heart rate (HR) trends during WCD use. In the current study, we assessed resting HR trends (nighttime: midnight-7am) in women, both at the beginning of WCD use and at the end of WCD use to assess the adequacy of beta-blockade following a typical 3 months of therapy optimization with beta-blockers. An adequate heart rate control was defined as having a nighttime HR <70 bpm at the end of the 3 months.

Results

There were a total of 21,453 women with at least 30 days of WCD use (>140 hours WCD use on the first and last week). The mean age was 67 years (IQR 58–75). The mean nighttime heart rate was 72 bpm (IQR 65–81) at the beginning of WCD use, that decreased to 68 bpm (IQR 61–76) at the end of WCD use with therapy optimization. Women had an insufficient heart rate control with resting heart rate ≥70 bpm in 59% at the beginning of WCD use that decreased to 44% at the end of WCD use, but still remained surprisingly high. Interestingly, there were 21% of the women starting with HR ≥70 bpm at the beginning of use (BOU) who achieved adequate heart rate control by the end of use (EOU). Interestingly, 6% of women with adequate heart rate control at the start of therapy optimization ended up having higher heart rates >70 bpm at the end of the therapy optimization time period (Figure).

Figure 1

Conclusions

A significant proportion of women with heart failure and low ejection fraction do not reach an adequate heart rate control during the time of beta blocker initiation/titration. The wearble cardioverter defibrillator is a monitoring device that has been demonstrated in this study to appropriately identify patients with inadequate heart rate control at the end of the therapy optimization period. The WCD could be utilized to improve management of beta-blocker therapy in women and improve the achievement of adequate heart rate control in women.
P3518Men with heart failure have higher readmission rates: a closer review of sex and gender based analyses
Authors: Hoang-Kim A , Parpia C , Freitas C , Austin P C , Ross H J , Wijeysundera H C , Tu K , Mak S , Farkouh M E , Schull M , Rochon P , Mason R , Lee D S
Published: October 2019

Background

There has been increased attention on reducing hospital readmission rates. However, little is known about any difference in readmission rates in heart failure by sex, although evidence exists demonstrating differences in the etiology of heart failure. As a result, strategies to optimize readmission reduction programs and care strategies for women and men remain unclear.

Purpose

(1) To identify studies examining readmission rates according to sex, and (2) to provide a qualitative overview of possible considerations for the impact of sex or gender.

Methods

A scoping protocol was developed using the Arksey and O'Malley framework and the Joanna Briggs Institute methodology. Our search strategy was reviewed according to the peer-review of electronic search strategy (PRESS) checklist. Full text articles published between 2002 and 2017 and drawn from multiple databases (i.e. MEDLINE, EMBASE), grey literature (i.e. National Technical Information, Duck Duck Go), and experts were consulted for additional articles. Screening criteria were established a priori. Once an acceptable inter-rater agreement was established at 80% by two independent reviewers, articles were screened for potential eligibility. A descriptive analytical method was employed to chart primary research articles. Articles were considered relevant if the cohort consisted of adult heart failure patients who were readmitted after an index hospitalization and a sex/gender-based analysis was performed.

Results

The literature search yielded 5887 articles, of which 746 underwent full text assessment for eligibility. Of 164 eligible articles, 34 studies addressed the primary outcome, 103 studies considered sex differences as a secondary outcome and 25 studies included disaggregated data for sex but no subsequent interaction was reported. Good inter-rater agreement was reached: 83% for title and abstract screening; 88% for full text review; kappa: 0.69 (95% CI: 0.526–0.851). Twelve of 34 studies included for the primary outcome reported higher readmission rates for men compared to five studies reporting higher readmission rates for women. However, there were differential readmission rates that were dependent on duration of follow-up. Women were more likely to experience higher readmission rates than men when time to event was less than one year. Readmission rates for men were higher when follow-up was longer than one year.

Conclusion

Sex differences in readmission rates were dependent on follow up time. Most studies used composite outcomes and had short times to event, which may mask underlying effects of sex on readmission.

Acknowledgement/Funding

Ontario SPOR Support Unit
P3534Optimal dosing of initial bolus of intravenous furosemide in acute heart failure: insights from REALITY-AHF
Authors: Matsue Y , Okumura T , Kida K , Oishi S , Akiyama E , Suzuki S , Yamamoto M , Kitai T
Published: October 2019

Background

Although intravenous diuretics are a cornerstone in the treatment of patients with acute heart failure (AHF), optimal dosing of initial bolus of IV diuretics has not been well elucidated.

Methods

The initial IV bolus dose of furosemide and its association with outcomes were analyzed in 1290 AHF patients (median age, 81 years, 55% were male) derived from REALITY-AHF (Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure). The patients were divided into 3 groups; lower dose (lower than recommended dose, n=371), standard dose (same as recommended dose, n=807), and higher dose (higher than recommended dose, n=112) groups according to the recommended initial IV bolus furosemide dose derived from the maintenance loop diuretics dose (for those without taking oral loop diuretics or taking ≤40mg/day oral furosemide-equivalent loop diuretics, 20mg IV bolus furosemide; those on >40mg/day oral furosemide-equivalent loop diuretics, IV bolus furosemide at the same dose as oral loop diuretic dose). Outcomes were length of hospital stay, diuretic response (urine output achieved within 48 hours of admission per 40 mg furosemide-equivalent diuretics dose), and 60-day all-cause mortality.

Results

Median amount of first IV bolus furosemide dose were 10, 20, and 40 mg for lower, standard, and higher dose groups, respectively. After adjustment for other covariates, length of hospital stay was significantly longer by 2.6 days (p=0.018) in the lower dose group compared to the standard dose group, and there was no difference between the standard and high dose groups (p=0.221). Diuretic response within 48 hours of admission was significantly better in the lower dose group (beta coefficient: 244 mL, p=0.025) and significantly worse in the higher dose group (beta coefficient: - 1098 mL, p<0.001) compared to the standard dose group after adjustment for covariates. During 60 days of admission, 91 deaths were observed, and 60-day mortality was significantly higher in the higher dose group (HR: 2.80, 95% CI: 1.49–5.26, p=0.001), but not in the lower dose group (HR: 1.18, 95% CI: 0.67–2.08, p=0.571) compared to the standard dose group after adjustment for other prognostic factors.

Conclusion

Treatment with the recommended initial bolus of IV furosemide is associated with a shorter hospital stay compared to lower dose regimen and better diuretic response and better 60-day survival compared to higher dose regimen in patients with AHF.

Acknowledgement/Funding

This study was funded by The Cardiovascular Research Fund, Tokyo, Japan.
P3552Estimating left ventricular myocardial deformation during cardiopulmonary exercise testing in patients with dilated cardiomyopathy and reduced ejection fraction
Authors: Triantafyllidi H , Birba D , Ikonomidis I , Makavos G , Benas D , Cokkinos D V , Iliodromitis E
Published: October 2019

Background

Cardiopulmonary exercise testing (CPET) has been recognized as a valuable tool regarding the integrated estimation of exercise ability in patients with several cardiopulmonary diseases, dilated cardiomyopathy (DCM) included. Left ventricular (LV) abnormal myocardial deformation might be studied by newer echocardiography techniques. Aim of this study is to explore differences of LV myocardial deformation in DCM patients during a CPET session.

Methods

Forty-four DCM patients (mean age 53±13 years, 34 men) with an ejection fraction <50% (mean EF = 33±10%) and no history of previous pulmonary disease were subjected to maximum CPET. Simultaneously, we estimated LV myocardial deformation using speckle tracking imaging and we measured global longitudinal strain (GLS), longitudinal strain rate both at systole (GLSrS) and diastole (GLSrE) at baseline and at peak exercise. The difference between GLS at baseline-GLS at peak exercise was defined as GLS difference.

Results

All patients finished uneventfully CPET (peakVO2 = 20±7 ml/min/kg) and improved GLS at peak exercise (GLS difference = 1.5±2). We found that at peak exercise, systolic blood pressure (SBP) was increased (119±14 vs. 159±23 mmHg, p<0.001) while GLS (−12.5±4 vs. −14±5, p<0.001), GLSrS (−0.7±0.2 and −1.0±0.4, p<0.001) and GLSrE (0.7±0.4 and 1.0±0.6, p=0.001) were improved. A positive correlation between peakVO2 and GLS difference was found, independent of peak SBP (β=0.38, p=0.01).

Relationship between GLS dif and CPET

Conclusions

Patients with dilated cardiomyopathy and ejection fraction <50% present an increased exercise ability when they manage to improve LV GLS during maximum exercise. Consequently, LV GLS improvement during exercise characterizes beside patient's exercise ability the severity of heart failure as well.
P3576Histopathological validation of optical coherence tomography assessment for cholesterol crystals
Authors: Tanaka A , Taruya A , Katayama Y , Akasaka T , Kondo T
Published: October 2019

Background

Cholesterol crystals (CCs) are well recognized as one of important components of advanced atherosclerotic plaques. Whilethe consensus document for intravascular optical coherence tomography (OCT) has proposed that CCs are appeared as thin, linear regions of high-signal intensity within a plaque, no study has validated CCs assessment by OCT in comparison with histopathology.

Purpose

Thepurpose of this study was to validate OCT assessments of CCs with histopathology.

Methods

A total of 27 diseased coronary artery samples (10–20 mm length) were resected from 7 randomly selected cadavers. OCT imaging was performed for the samples. Then, arterial samples were fixed in 10% formalin for ≥48 hours, decalcified and processed for standard paraffin embedding. Sections 5μm thick were sliced at the ink-marked imaging sites and stained with hematoxylin and eosin, and Masson's Trichrome. An independent pathologist blinded to the OCT results diagnosed all of the plaques. Subsequently, the OCT images were interpreted by an observer blinded to the histological results. In the OCT assessment, CCs were defined as thin, linear regions of high-signal intensity within a plaque.

Results

We obtained 27 pairs of OCT/ histopathology. CCs were diagnosed by histology in 10 (37%) of the 27 pairs. The sensitivity and specificity of OCT for detecting CCs were 60% and 94%, respectively.

Conclusion

OCT has a high specificity but modest sensitivity for detection of CCs in comparison with histopathology. CCs diagnosed with OCT would help the identification of advanced atherosclerotic plaques.

Acknowledgement/Funding

JSPS KAKENHI 17K09557
P3577Predictors analysis of restenosis in calcified nodule with OCT-guided PCI
Authors: Shibata H , Kijima Y , Nagoshi R , Kozuki A , Fujiwara R , Suzuki A , Kakizaki S , Fujimoto D , Kyo S , Masuko E , Miyata T , Shite J
Published: October 2019

Background

Recent reports show that stenting for coronary calcified nodule (CN) resulted in frequent in-stent restenosis, however, its predictors are unclear.

Method

117 consecutive calcified nodule lesions which underwent optical coherence tomography (OCT)-guided PCI were analyzed between January 2013 and March 2018. We investigated baseline characteristics and OCT parameter in CN site (Arc of CN, Lumen area and Symmetry index before and after PCI).

Result

CN site in-stent restenosis was seen 35 lesions (29.9%). Baseline characteristics was significantly different between restenosis group and non-restenosis group (Age; 68.9y.o vs. 73.3y.o, p=0.01, diabetes mellitus; 80.0% vs. 57.3%, Chronic Kidney Disease (CKD); 74.3% vs. 36.6%, Hemodialysis; 54.3% vs. 12.2%). Arc of CN before PCI in restenosis group was larger than that in non-restenosis group (122.7 vs. 110.0 degrees, p=0.01). Post stent symmetry index in restenosis group was smaller than that in non-restenosis group (0.64 vs. 0.75, p<0.01).

Conclusion

Younger patients, diabetes mellitus, CKD, hemodialysis, arc of CN before PCI, post stent symmetry index may be predictors of CN site restenosis.
P3579Clinical characteristics of an intracoronary erosion and thrombus in patients with vasospastic angina
Authors: Teragawa H , Oshita C , Ueda T , Kihara Y
Published: October 2019

Background

Intracoronary erosion and thrombus are sometimes detected in patients with vasospastic angina (VSA) through intracoronary imaging modalities. However, the clinical characteristics of these intracoronary findings remain unclear. Therefore, we assessed the clinical and lesion characteristics of these intracoronary abnormalities in patients with VSA.

Methods

We included 48 patients with VSA who underwent coronary angiography (CAG), spasm provocation test (SPT), and coronary angioscopy (CAS). In all patients, acetylcholine was infused in the left and right coronary arteries. The vessels were classified into spastic vessels (SVs) and non-spastic vessels (NSVs) based on SPT results. SVs that could not be observed using CAS were excluded from the study. CAG and SPT findings were evaluated for the presence of atherosclerotic lesions (%stenosis <30%) and types of spasm (segmental or diffuse). Two experts examined the presence of an intracoronary erosion and thrombus on CAS. Other serious symptoms such as cold sweating or syncope were also assessed.

Results

Among the 48 patients, intracoronary erosion and thrombus were detected in 11 (23%) and 10 (21%) patients, respectively, and total intracoronary abnormalities were observed in 17 (35%) patients. Male sex (p<0.05), smoking (p<0.05), and presence of other serious symptoms (p<0.01) were associated with the presence of intracoronary abnormalities. The logistic regression analysis showed the presence of other serious symptoms to be the only factor associated with the presence of intracoronary abnormalities (p<0.05). In the lesion analyses, among the 72 vessels, intracoronary abnormalities were observed only in SVs (17/53, 33%) but not in NSVs (0/19, 0%, p<0.01). Among the 53 SVs, the presence of atherosclerotic lesions (p<0.05) and segmental spasm type (p<0.05) were found to be associated with the presence of intracoronary abnormalities.

Conclusions

Intracoronary erosion and thrombus were observed in approximately 35% of patients with VSA. Such intracoronary abnormalities may be partly affected by the forms of the coronary artery and coronary spasm, leading to the onset of serious symptoms of VSA.
P3584Optimal medical therapy improves survival in patients with ischaemic cardiomyopathy: an analysis of the STICH trial
Authors: Wolfe N , Mitchell J D , Brown D L
Published: October 2019

Background

Prior studies have demonstrated underuse of optimal medical therapy (OMT) in patients with coronary artery disease (CAD) after revascularization. However, there are limited studies assessing compliance with OMT on long-term survival in patients with CAD and no studies evaluating the impact of OMT in patients with severe CAD and reduced left ventricular (LV) function. The Surgical Treatment for Ischaemic Heart Failure (STICH) Trial was a randomized clinical trial that compared coronary-artery bypass grafting (CABG) with medical therapy versus medical therapy alone in the treatment of ischemic cardiomyopathy.

Purpose

This study sought to determine compliance with OMT over time and the impact of OMT compliance on survival in patients with or without revascularization.

Methods

STICH was a multicenter, randomized clinical trial of patients with an LV ejection fraction of 35% or less and CAD amenable to CABG who were randomized to CABG plus medical therapy (N=610) or medical therapy alone (N=602). A medication history was obtained at hospital discharge or 30 days after enrollment, 1 year, 5 years, and 10 years. OMT was defined as the combination of at least 1 antiplatelet drug, a statin, a beta-blocker, and an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker. The primary outcome was all-cause mortality. Comparison of mortality between the OMT and non-OMT groups was performed using multivariate Cox regression modeling with OMT as a time-dependent covariate.

Results

Of the 1212 patients randomized, at a median follow-up of 9.8 years, all-cause mortality was 58.9% in the CABG group and 66.1% in the medical therapy group. In the CABG arm, 63.6% of patients were on OMT throughout the study period compared to 66.5% of patients in the medical therapy arm (p=0.3). Those on OMT were younger (59.6 vs. 61.4 years, p<0.001); were more often in NYHA class I-II (67.4% vs. 56%, p<0.001); and lower rates of atrial fibrillation (9.4% vs. 18.1%, p<0.001), current smoking (18.6% vs. 24.5%, p=0.015), and depression (4.8% vs. 8.8%, p=0.005). Those on OMT had higher rates of hyperlipidemia (63.8% vs. 54.4%, p=0.001) and prior myocardial infarction (79.4% vs. 73.1%, p=0.01). There was no difference in sex, diabetes, and hypertension between those on OMT and non-OMT. In multivariate survival analysis, OMT was associated with a significant reduction in mortality (adjusted hazard ratio, 0.69; 95% confidence interval, 0.58–0.81; p<0.001). The treatment effect with OMT (31% relative reduction in mortality over 10 years) was numerically greater than the treatment effect of CABG (24% relative reduction in mortality with CABG versus medical therapy alone).

Conclusions

OMT improves long-term survival in patients with ischaemic cardiomyopathy regardless of revascularization status. Strategies to improve OMT use and adherence in this population is needed to maximize survival.
P3600High-sensitivity troponin I can predict reduced TIMI coronary grade flow in patients with suspected myocardial infarction
Authors: Schaefer S , Neumann J T , Soerensen N A , Gossling A , Ojeda F , Blankenberg S , Westermann D
Published: October 2019

Background

Serial measurements of high-sensitivity troponin (hs-Tn) is recommended for rule-out or rule-in of myocardial infarction (MI) in patients presenting with acute chest pain. Based on dynamic hs-Tn changes invasive angiography is recommended in order to identify a culprit lesion. However, the association of hs-Tn with the intracoronary flow is unknown.

Purpose

We aimed to evaluate the association of hs-TnI with intracoronary flow, measured by the TIMI Coronary Grade Flow in coronary angiography, and its association with outcome.

Methods

1,940 consecutive patients presenting with suspected MI to the emergency department were included. Among those 543 patients underwent coronary angiography. Patients with prior coronary artery bypass graft surgery and patients with chronic total occlusion were excluded from further analysis, resulting in 420 available individuals. TIMI Coronary Grade Flow was scored in accordance with the definition of the TIMI study group. For further analysis two groups were distinguished. Group 1: Minimum TIMI Grade Flow <3 (no complete perfusion in at least one of the coronary arteries) and Group 2: Minimum TIMI Grade Flow = 3 (normal flow in all coronary arteries). Troponin I was measured using the ARCHITECT STAT high sensitive Troponin I immunoassay directly at admission, after 1 and 3 hours. Receiver Operating Characteristic (ROC) curves were used to investigate the association of hs-TnI with a reduced TIMI Grade Flow. Survival curves were produced for a combined endpoint of all-cause mortality, rehospitalisation, PCI and MI after 12 months.

Results

In patients with reduced TIMI Grade Flow the level of hs-TnI was significantly higher at admission (Group 2: 87.3 ng/l vs. Group 1: 15.0 ng/l, p<0.001), after 1 hour (298.3 ng/l vs 18.5 ng/l, p<0.001) and after 3 hours (1,071 ng/l vs. 27.7 ng/l, p<0.001). The prediction of reduced TIMI flow based on the absolute value of hs-TnI improved over time from admission (AUC 0.701, optimal cut off 34.8 ng/l, 95% CI (9.7, 74.6)), to 1 hour (AUC 0.759, optimal cut off 65.1 ng/l, 95% CI (25.1, 279.5)) and 3 hours (AUC 0.777, optimal cut off 90.7 ng/l, 95% CI (14.8, 200)). Using the hs-TnI delta to predict a reduced TIMI Grade Flow improved the accuracy only slightly with time from admission: hs-TnI 0/1h delta (AUC 0.758) vs. 0/3h delta (AUC 0.765). The survival curve for a combined endpoint after one year was significantly reduced in patients with reduced TIMI Grade Flow (Figure 1, p=0.012)

Figure 1

Conclusion

Absolute value and delta change of hs-TnI after 1 and 3 hours help to predict the presence of reduced TIMI Grade Flow in coronary arteries. Patients suffering from a lowered TIMI Grade Flow have higher event rates after 12-months.
P3607Temporal trends in the characteristics, management, and clinical outcomes of patients with prior myocardial infarction who are admitted with an acute coronary syndrome
Authors: Eisen A , Schechter A , Itzhaki Ben Zadok O , Harari E , Shlomo N , Iakobishvili Z , Kornowski R , Zusman O
Published: October 2019

Background

Patients with prior myocardial infarction (MI) are at increased risk for recurrent cardiovascular events. Advances in treatment in the last decade has improved prognosis of patients with acute coronary syndrome (ACS), yet it is not known whether similar trends exist in patients with prior MI who are admitted with an ACS, a particularly high-risk group.

Methods

Patients admitted with ACS who were enrolled in the ACS Israeli Surveys (ACSIS). Patients were stratified by early (2000–2008) and late (2010–2016) time-periods and by prior MI status. Clinical outcomes included 30-d MACE (death, MI, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality.

Results

A total of 15,211 ACS patients were included, of whom 4627 (30%) had a prior MI. These patients were older (67y vs. 63y), more commonly male, had more prior comorbidities, and a higher proportion had a GRACE score>140 (38.4% vs 12.2%). Patients with prior MI received more prior medications such as aspirin, statins, antihypertensives and hypoglycemics. During time, utilization of guideline-recommended therapies such as P2Y12 inhibitors, statins, and PCI had significantly improved in patients with prior MI. However, compared with patients without prior MI, they were still treated less commonly by PCI (61% vs. 74%). Overall, patients with prior MI had a higher 30-d MACE (13.7% vs 17.2%, p<0.001) and 1-year mortality (8.2% vs. 13.1%, p<0.001). In patients with prior MI, during time, 30d MACE nearly halved (22.7% to 11.8%) and 1-year mortality also decreased (15.5% to 10.7%). Upon adjustment, prior MI was independently associated with 1-year mortality (HR 1.13, 95% CI 1.01–1.26, p=0.04) and the late time-period was associated with reduced 1-year mortality (HR 0.75, 95% CI 0.65–0.84, p<0.001).

Conclusion

Patients with prior MI have a worse prognosis after ACS despite being treated with prior medications and improvement in guideline-based therapies. Although still undertreated, their clinical outcome has significantly improved throughout the years.