bluuebunny/crossref_metadata_2025 huggingface dataset:
P794Long-term prognostic value of the combination of AHEAD score and wasting syndrome in patients admitted for acute decompensated heart failure with reduced or preserved LV ejection fraction
Authors: Yamada T , Morita T , Furukawa Y , Tamaki S , Kawasaki M , Kikuchi A , Kawai T , Seo M , Nakamura J , Abe M , Yamamoto K , Kayama K , Kawahira M , Tanabe K , Fukunami M
Published: October 2019

Background

Comorbidities are associated with poor clinical outcome in heart failure patients (pts). AHEAD (A: atrial fibrillation; H: hemoglobin; E: elderly; A: abnormal renal parameters; D: diabetes mellitus) score has been related to clinical outcomes in acute decompensated heart failure (ADHF) pts. On the other hand, heart failure is one of a number of disorders associated with the development of wasting syndrome. Previous studies have reported reduced mortality rates in heart failure patients with increased body mass index (BMI), so-called, obesity paradox. We sought to investigate the prognostic value of the combination of AHEAD score and the cachectic state in ADHF pts, relating to reduced or preserved LVEF (HFrEF or HFpEF).

Methods and results

We studied 303 pts admitted for ADHF and discharged with survival (HFrEF (LVEF <50%); n=163, HFpEF (LVEF ≥50%; n=140). We evaluated AHEAD score (range 0–5, atrial fibrillation, hemoglobin <13 mg/dL for men and 12 mg/dL for women, age >70 years, creatinine >130 μmol/L, and diabetes mellitus) and wasting syndrome was defined as BMI <20 kg/m2 and serum albumin level (Alb) <3.2 g/dl at the discharge. During a follow-up period of 5.1±4.2 years, 121 pts died. At multivariate Cox analysis, AHEAD score and wasting syndrome was significantly and independently associated with the total mortality, in pts with not only HFrEF but also HFpEF. Pts with both high AHEAD score (≥3: AUC 0.625 [0.542–0.709] in HFrEF and ≥3: AUC 0.611 [0514–0.708] in HFpEF, by ROC curve analysis) and wasting syndrome had a higher risk of mortality than those with either and none of them in HFrEF (71% vs 51% vs 40%, p<0.0001, respectively) and HFpEF (78% vs 33% vs 24%, p<0.0001, respectively).

Conclusion

The combination of AHEAD score and wasting syndrome would be useful for stratifying patients at risk for the mortality in ADHF pts, regardless of HFrEF or HFpEF.
P797Association of office and ambulatory blood pressure with mortality and cardiovascular endpoints
Authors: Yang W.-Y , Melgarejo J D , Thijs L , Zhang Z.-Y , Wei F.-F , Hansen T W , Asayama K , Staessen J A
Published: October 2019

Background

Blood pressure (BP) is the strongest modifiable risk factor predicting death and cardiovascular complications. However, which BP index has greater clinical relevance is not established.

Purpose

To compare associations of adverse health outcomes with commonly used BP indexes.

Methods

Longitudinal population-based cohort study of 11,135 adults recruited in Europe, Asia and South America with baseline observations collected from 1985 until 2010 and last follow-up year ranging from 2006 to 2016. Multivariable-adjusted analyses addressed the associations of primary endpoints (total mortality and composite CV endpoints) and secondary endpoints (CV mortality, cardiac and coronary endpoints and stroke) with conventional BP, automated office BP and ambulatory BP indexes. Model performance was assessed by the integrated discrimination improvement (IDI) and change in the area under the curve (ΔAUC).

Results

The study included 49.3% women. Median age was 54.7 years. Over 13.8 years (median), 2836 participants died (18.5 per 1000 person-years) and 2049 (13.4 per 1000 person-years) experienced a cardiovascular endpoint. Both endpoints were related to all single systolic BP (SBP) indexes (P<0.001). In models that included both 24-h and nighttime SBP, the HRs for total mortality and the cardiovascular endpoint in relation to 24-h SBP were 0.98 (95% confidence interval, 0.92–1.06) and 1.17 (1.08–1.28) and HRs associated with nighttime SBP were 1.18 (1.11–1.27) and 1.12 (1.04–1.21), respectively. Otherwise, depending on the SBP index combined with 24-h or nighttime SBP, HRs for both endpoints associated with 24-h or nighttime SBP retained significance (P≤0.004), ranging from 1.12 (1.07–1.17) to 1.56 (1.41–1.74). In models that included either 24-h or nighttime SBP, HRs associated with other SBP indexes weakened, lost significance or reversed. IDI and ΔAUC for adding 24-h or nighttime SBP to other SBP indexes were consistently greater than unity except for combining 24-h and nighttime SBP. These findings were consistent for secondary endpoints, for systolic and diastolic BP, and in sensitivity analyses performed to evaluate the influence of antihypertensive drug treatment at baseline, various definitions of day and night, and the contribution of different cohorts to the overall results.

Conclusions

Associations of outcomes were strongest for 24-h and nighttime ambulatory BP, which outperformed all other BP indexes in predicting 10-year absolute risk and which should therefore be prioritised in clinical practice.

Acknowledgement/Funding

The European Union, the European Research Council, the European Research Area Net for Cardiovascular Diseases, et al.
P829The impact of APOC3 and APOE gene polymorphisms on response to statin therapy in acute myocardial infarction
Authors: Teterina M , Geraskin A , Potapov P , Babaeva L , Pisaryuk A , Goreva L , Balatskiy A , Meray I , Kobalava Z
Published: October 2019

Background and aim

Many genetic studies have been reported about the association between APOE, APOC3 gene polymorphisms and response to statin therapy in myocardial infarction, but results remain controversial. The aim of this study was to investigate the association between SNP rs7412 (APOE), rs2854117 (APOC3), rs2854116 (APOC3) and lipid-lowering effect of atorvastatin and rosuvastatin in patients with myocardial infarction.

Methods

Polymorphism of genes APOE (rs7412), APOC3 (rs2854117 and rs2854116) was determened. Lipid profile was determined on admission and after 1 year of treatment.

Results

78 patients with myocardial infarction treated with maximal tolerated dose of atorvastatin or rosuvastatin were included. More pronounced reduction of lipid levels was associated with of T allele of rs7412 (APOE), p<0,05. ANOVA demonstrated greater low-density lipoprotein and total cholesterol decrease in patients with combination of genes CT/TT (rs7412, APOE) and CC (rs2854117, APOC3) genotypes, CT/TT (rs7412, APOE) and CT (rs2854116, APOC3) genotypes.

Conclusion

The genetic variants of APOC3 and APOE are useful markers and can be use to predict response to lipid-lowering therapy with statin in myocardial infarction.
P830Differences in the usefulness of aggressive lipid-lowering therapy among single-vessel and multi-vessel coronary artery disease patients: HIJ-PROPER sub-study
Authors: Ogido M , Nomura H , Nakawaza M , Kawada-Watanabe E , Sekiguchi H , Arashi H , Yamaguchi J , Ogawa H , Hagiwara N
Published: October 2019

Background

Acute coronary syndrome (ACS) patients with multi-vessel disease (MVD) are at high risk of recurrent cardiovascular events. Previous study, examining stable atherosclerotic cardiac disease, reported that aggressive lipid-lowering therapy was more beneficial in MVD patients than in single-vessel disease (SVD) patients. However, no report has investigated the effects of aggressive lipid-lowering treatment according to the number of diseased coronary arteries in ACS patients.

Purpose

The purpose of the present study was to elucidate the efficacy of aggressive lipid-lowering therapy in ACS patients with MVD and SVD in modern early invasive strategy era.

Methods

The study population was derived from the HIJ-PROPER study, in which, ACS patients with dyslipidemia were randomized to pitavastatin + ezetimibe therapy (targeting LDL-C less than 70mg/dl) or pitavastatin-monotherapy (targeting LDL-C less than 90mg/dl). In the present study, the treatment efficacy was compared between patients with MVD and SVD. The primary end point was a composite of major advanced cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia driven revascularization.

Results

We identified 1702 eligible patients (mean age, 65.6 years; male, 75.6%); 869 patients (51.1%) had MVD and 833 (48.9%) patients had SVD. The rate of acute revascularization was 96.2%. The incidence of MACEs was significantly higher in MVD group compared to SVD group (43.7% vs 25.9%, hazard ratio 1.95, 95% confidence interval 1.65–2.31, p<0.001). In MVD group, there was no significant difference in MACEs between pitavastatin + ezetimibe therapy and pitavastatin-monotherapy group. (43.5% vs. 43.9%, 1.0, 0.82–1.23; p=0.95). However, in SVD group, pitavastatin + ezetimibe therapy showed significantly fewer MACEs than pitavastatin-monotherapy (34.6% vs. 47.4%, 0.72, 0.55–0.94, p=0.02). (Figure)

Conclusion

This study showed that ACS patients with SVD enjoyed significantly greater benefits from pitavastatin + ezetimibe therapy compared with pitavastatin monotherapy, whereas the patients with MVD did not. High rate of revascularization in acute phase of ACS might affect the efficacy of aggressive lipid-lowering therapy and our results in the present study suggest different treatment approach would be necessary in ACS patients with MVD in modern early invasive strategy era.
P831Effect of high-dose statin pretreatment in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: meta-analysis of randomized controlled trials
Authors: Burgos L M , Battioni L , Costabel J P , Trivi M
Published: October 2019

Introduction

Current guidelines recommend the use of high doses of statins in patients with acute coronary syndrome. However, up to now, there is not enough evidence about the time of its onset in patients with acute myocardial infarction with ST elevation (STEMI) undergoing primary angioplasty. We conducted a systematic review and meta-analysis with the aim of evaluating the efficacy of pre-treatment with statins in high doses in the short term in patients with STEMI treated with primary angioplasty.

Methods

A systematic search was carried out in Pubmed, EMBASE, Scopus and Cochrane database, LILACS, and references of relevant articles were searched manually. We included randomized clinical trials (RCTs) comparing pretreatment with high doses of statins (rosuvastatin/atorvastatin) with low doses or without treatment published until April 2018. We evaluated the incidence of MACE (death, spontaneous myocardial infarction, coronary revascularization and stroke) at 30 days. In addition the presence of final TIMI III flow, TIMI blush grade, CPK peak, stent thrombosis and death from any cause during follow-up were evaluated. The data were combined as relative risk (RR) or difference of means (DM) with their 95% confidence interval (CI), using RevMan software. The meta-analysis was performed with the fixed effects model or random effects according to the heterogeneity.

Results

Six RCTs met the inclusion criteria with a total of 1454 patients. The pretreatment with statins in high doses was associated with a decrease in MACE (RR 0.52 CI 95% 0.37–0.77, I2=0%, P=0.001). The pretreatment was not associated with a reduction of the final TIMI III flow (RR 1.03 CI 95% 0.98–1.09, I2=0%, P=0.1), CPK peak (MD 13.99 CI95% −12.68 to 40.6; I2=0%; P=0.3), or stent thrombosis (RR 0.54 CI95% 0.1–2.85; I2 = 0%; P=0.46), neither death in the follow-up (RR 0.52 CI95% 0.16–1.68, I2=0%, P=0.27). In addition, an improvement in the degree of myocardial blush TIMI was observed (MD 0.36 CI95% 0.20–0.52, I=0%, P<0.0001),

Conclusion

In this meta-analysis, treatment with high doses of statins prior to primary angioplasty in STEMI significantly reduced adverse cardiac events at 30 days. In addition, an improvement in the degree of myocardial blush was observed in the pretreatment group with high-dose statins. Therefore, the findings of this meta-analysis can help guide medical decision making regarding the time of onset of statins in STEMI.
P847Performance of the GRACE score in patients with type 1 and type 2 myocardial infarction
Authors: Hung J D , Roos A , Shah A S V , Anand A , Strachan F E , Fox K A , Mills N L , Chapman A R , Holzmann M
Published: October 2019

Introduction

The Global Registry of Acute Coronary Events (GRACE) score is a widely used risk stratification tool in the evaluation of patients with myocardial infarction. However, the performance of GRACE in patients with myocardial infarction secondary to oxygen supply-demand imbalance in the absence of atherothrombosis (type 2 myocardial infarction), is uncertain. Outcomes in patients with type 2 myocardial infarction are poor, and a risk stratification tool is urgently required.

Methods

We assessed the GRACE score in two cohorts of consecutive patients presenting to the Emergency Department with suspected acute coronary syndrome. One cohort was recruited as part of a stepped wedge cluster randomised controlled trial across ten hospitals in Scotland, and one cohort from a large tertiary centre in Sweden. All diagnoses were adjudicated according to the Fourth Universal Definition. We applied the GRACE 2.0 algorithm to estimate death at one year. We assessed model discrimination using the area under the receiver-operator-curve (AUC), and compared AUC between type 1 and type 2 myocardial infarction using the DeLong test. Calibration was assessed using the Hosmer-Lemeshow (HL) goodness of fit test.

Results

We identified 2,538 and 1,080 patients with type 1 myocardial infarction from the Scottish and Swedish cohorts, with death from any cause occurring in 378 (14.9%) and 112 (10.4%) patients, respectively. The AUC for the GRACE score was 0.843 (0.823–0.864) and 0.848 (0.810–0.886). There were 642 and 247 patients with type 2 myocardial infarction in the Scottish and Swedish cohorts, respectively, with death occurring in 144 (22.4%) and 57 (23.1%) patients. The AUC was 0.708 (0.662–0.754) and 0.733 (0.657–0.808), (P<0.001 for both compared to type 1 myocardial infarction). The results of the HL Test suggest that the calibration of the GRACE 2.0 score needs further improvement (Table).

Evaluation of GRACE 2.0 algorithm Type 1 Myocardial Infarction Type 2 Myocardial Infarction Scotland (n=2,538) Sweden (n=1,080) Scotland (n=642) Sweden (n=247) Deaths 378 (14.9%) 112 (10.4%) 144 (22.4%) 57 (23.0%) AUC (C-statistic) 0.843 (0.823–0.864) 0.848 (0.810–0.886) 0.708 (0.662–0.754) 0.733 (0.657–0.808) P-value for HL <0.001 <0.001 <0.001 <0.001 AUC: Area Under the receiver-operator Curve; HL: Hosmer-Lemeshow test.

Figure 1. ROC curves

Conclusions

The GRACE score provided excellent discrimination for all cause death at one year in two contemporary consecutive patient cohorts with tye 1 myocardial infarction. In patients with type 2 myocardial infarction, GRACE performed well, but recalibration or the development of novel risk scores has the potential to improve risk stratification.
P859Infective endocarditis requiring surgical intervention: safety and therapeutic impact of preoperative coronary angiography
Authors: Laperche C , Lairez O , Elbaz M , Carrie D , Galinier M , Marcheix B , Gautier M , Robin G , Bouisset F
Published: October 2019

Introduction

Preoperative coronary angiography (CA) cannot be performed systematically in patients with infective endocarditis requiring surgical treatment due to a high risk of embolization, in cases of aortic endocarditis, or when abscesses or vegetations are present.

Purpose

The aim of this study is to assess the safety and the therapeutic impact of preoperative coronary angiography in infective endocarditis requiring surgery.

Methods

This monocentric, observational study included patients with infective endocarditis requiring surgical treatment who were hospitalized between March 2013 and December 2016 in our Hospital. The outcome were i) the occurence of post-CA complications, such as neurological embolization, acute kidney failure requiring post-operative dialysis, or ii) necessity for surgical myocardial revascularization, and the mortality at 28 days and one year.

Results

193 patients were included among which 178 were effectively operated on. 119 patients had an aortic endocarditis with an aortic vegetation for 74 patients. Invasive coronary angiography was performed in 142 patients (91.6% by radial approach), and 14 patients were evaluated by coronary tomodensitometry (one patient had exploration with both techniques).

CA was carried out regardless of the location of the endocarditis, whether it was aortic or not (p=0,39), and regardless of the existence of abscesses and/ or adenoids (p=0,09), even in case of emergency surgery (p=0,79). Among the 178 patients operated on, 35 had significant coronary lesion(s) and 25 underwent an associated artery bypass graft.

Neurological embolization occurred after angiography in only 2 patients with mitral endocarditis, and none was observed in patients with aortic endocarditis. Acute renal failure after CA was observed in 15 (10.6%)

Surgery was performed in 173 patients, and 25 of them had a myocardial revascularization. No increase in post-operative dialysis rate was observed (p=0,43) and there were no differences in the mortality rates, neither at 28 days (p=0,77) nor at 12 months following surgery (p=0,59).

Conclusion

Preoperative CA was not associated with a higher occurence of complications, such as embolizaton or post-operative acute kidney failure, and did not decrease post-operative mortality in infective endocarditis (aortic or not) requiring surgery.
P889Clinical significance of four-dimensional flow magnetic resonance imaging measurement of turbulent kinetic energy for hypertrophic obstructive cardiomyopathy
Authors: Matsuda J , Takano H , Sekine T , Sangen H , Kubota Y , Imori Y , Nakata J , Saiki Y , Miyachi H , Tara S , Hosokawa Y , Tokita Y , Yamamoto T , Kumita S , Shimizu W
Published: October 2019

Four-dimensional flow magnetic resonance imaging (4D flow MRI) provides the detailed visualization of complex blood flow patterns and the evaluation of energy loss. Turbulent kinetic energy estimation (TKE) is reported to have good correlation with irreversible pressure loss in patients having aortic stenosis or great vessel disease. However, little is known about the usefulness of 4D flow MRI and the significance of TKE value in hypertrophic cardiomyopathy (HCM).

Purpose

The aims of this study were to investigate the relationship between TKE value and echocardiographic findings, clinical symptoms and evaluate the usefulness of 4D flow MRI to distinguish hypertrophic obstructive cardiomyopathy (HOCM) from non-obstructive HCM (HNCM).

Methods

From April 2018 to January 2019, 18 hypertrophic obstructive cardiomyopathy (HOCM) and 14 non-obstructive HCM (HNCM) patients underwent 4D flow MRI. We investigated TKE value calculated by 4D flow MRI, echocardiographic findings; left ventricular pressure gradient (LVPG), mitral regurgitation (MR) and clinical symptom.

Results

HOCM was defined by the 30 mmHg or greater of LVPG (HOCM: 87.7±47.3 mmHg, HNCM; 5.8±7.8 mmHg, p<0.001). TKE value in HOCM patients was significantly higher than HNCM (14.2±4.7 mJ vs. 9.0±4.6 mJ, p<0.001). There was a significant positive linear relationship between TKE value and LVPG (r=0.488, p=0.046). There was no significant relationship between NYHA functional class and TKE value (p=0.47) or LVPG (p=0.11). ROC curve analysis showed that optimal cut off point of TKE value between HOCM and HNCM (sensitivity=95%, specificity=62%, AUC=0.798) was 9.270 mJ. Multiple linear regression showed that there was significant association between severity of MR and combination of TKE (p=0.015) or LVPG (p–=0.012). A representative case demonstrated the significant reduction of TKE value 1 week and 3 months after alcohol septal reduction compared with that obtained before the procedure (Figure)

Conclusion

Our findings suggest that 4D Flow MRI can effectively evaluate the energy dissipation associated with LV outflow tract obstruction and TKE value is useful for identifying HOCM. TKE value also can be the novel parameter of the severity of HOCM.
P890Gene carriers of hypertrophic cardiomyopathy, what to expect over time
Authors: Poveda Velazquez P , Basu J , Homfray T , Papadakis M , Behr E , Sharma S , Tome M
Published: October 2019

Background

Data on the natural history of genotype positive/phenotype negative (G+/P-) hypertrophic cardiomyopathy (HCM) patients identified as a part of genetic cascade screening in different age groups is limited.

Purpose

To describe the rate of conversion to overt HCM phenotype in G+/P- subjects in relation with the age who were identified in a specialized clinic in a single center.

Methods

We retrospectively identified 56 consecutive HCM G+/P− subjects followed in our center specialized clinic between Jan 2012-Jan 2019. Demographics, family history of sudden cardiac death (SCD) and presence of symptoms were collected. All of them underwent baseline investigations including ECG, echocardiogram and/or cardiac magnetic resonance (CMR) and 24 hour monitor at baseline and during follow up. Overt HCM phenotype was defined as left ventricular hypertrophy (LVH) ≥13mm in the echocardiogram or CMR.

Results

We identified 56 HCM G+/P− subjects from 34 different families. 22 subjects were ≤18 years old with a mean age of 11.6±0.9 years (IQR [P25-P75] 9–16 years) and 32 subjects were >18 years old with a mean age of 38.1±2.2 years (IQR [P25-P75] 27–48 years). Mean time of follow up was 35.2±34.4 months (IQR [P25-P75] 4.25–50.25 years). 60.7% (34) of them were female and 82.1% (46) were of Caucasian ethnicity. Most of the subjects with no evidence LVH were asymptomatic but small number had symptoms, 8.9% (5), and 3.6% (2) were treated with betablockers for palpitations. Family history of SCD was present in 57.1% (32) of the subjects and 35.7% (20) had a relative with an implantable cardiac defibrillator (ICD). MYBPC3 gene mutations were identified in 62.5% (35) of subjects, followed by MYH7 gene mutation in 23.2% (13) of the cases.

None of the subjects under 18 year old developed HCM during the period of observation, however 7 subjects (21.9%), mean age 48.6±10.5 years, 71.4% (5) females, showed progression to HCM in the >18 years old group. All of them had pathogenic MYBPC3 gene variants. No differences were found in gender, ethnicity, symptoms or family history of SCD in the G+/P− vs HCM group. There were no differences on the presence of ECG abnormalities and no episodes of NSVT were recorded in any of the groups. Baseline E/e' values of those with new HCM vs G+/P− were higher (8.2±3.3 vs 5.6±1.7, p=0.014).

Conclusions

In our cohort, rate of progression to HCM phenotype was 21.9% of >18 years old HCM G+/P- subjects. The mean age at the time of developing the phenotype was 48.6±10.5 years old and all the patients were asymptomatic for cardiac symptoms. Echocardiographic E/e' values were increased. This data supports the need of life long follow up of this group of patients with ongoing clinical evaluation.

Acknowledgement/Funding

ESC clinical grant
P894The association of the polymorphic variant rs1739843 of the hspb7 gene with clinical profile and outcomes in patients with hypertrophic cardiomyopathy (10 years follow-up)
Authors: Streltsova A , Gudkova A , Poliakova A , Pyko S , Kostareva A
Published: October 2019

Purpose

The aim of this study was to determine the impact of polymorphic variant rs1739843 of the hspb7 gene on clinical profile and outcomes in patients with hypertrophic cardiomyopathy (HCM).

Methods

The study population consisted of 108 patients with HCM ≥45 years old. The control group included 192 healthy donors. A novel disease pathway model, firstly designed in foreign outcome study (2017), was employed to assess clinical course of HCM. SNP rs1739843 of the hspb7 gene was genotyped by allele-specific real-time polymerase chain reaction (PCR) assay.

Results

It was found a significant increase in TT genotype frequency of rs1739843 of the hspb7 gene in patients with HCM (n=108) – 20.4%, compared with control group (n=192) – 4.2% (TT: TC+CC, odds ratio (OR) = 5.88, 95% confidence interval (CI) = 2.52–13.75, p<0.001). High prevalence of CC genotype of rs1739843 of the hspb7 gene was observed in control group – 80.2% vs 31.5% in HCM (CC: TC+TT, OR = 0.11, 95% CI = 0.07–0.19, p<0.001). The allele frequency (C: T) also differed between HCM and control groups – 55.6: 44.4% in HCM, vs 88.02: 11.98% in control group (OR = 5.88, 95% CI = 3.91–8.85, p<0.001). It was also found a significant increase in TT genotype frequency of rs1739843 of the hspb7 gene in HCM patients with benign course free of adverse pathways (n=48) – 16.7%, compared with control group (n=192) – 4.2% (TT: TC+CC, OR= 4.60, 95% CI = 1.63–12.99, p<0.001)). The allele frequency (C: T) in HCM patients with benign course free of adverse pathways was 56.3: 43.7% vs 88.02: 11.98% in control group (OR = 5.71, 95% CI= 3.44–9.49, p<0.001). The mortality rate of HCM patients with 1, 2 or 3 adverse pathways was higher compared with HCM patients with benign course free of adverse pathways. HCM patients ≥45 years old showed a significant increase in T allele frequency in cases of presence of 2 (CHF (chronic heart failure) III–IV functional class (NYHA) + AF (atrial fibrillation)) and 3 adverse pathways (CHF III-IV functional class (NYHA) + AF + SCD (sudden cardiac death) of HCM progression.

Conclusions

The T allele and TT genotype of rs1739843 of the hspb7 gene were more frequent in patients with HCM ≥45 years old, compared with control group. It was also found a significant increase in frequency of TT genotype and T allele of rs1739843 of the hspb7 gene in HCM patients with benign course free of adverse pathways, compared with control group. HCM progression along 2 and more adverse pathways in patients ≥45 years old has been characterized with adverse outcome. Allele T of rs1739843 of the hspb7 gene was associated with 2 and more adverse pathways of HCM progression.
P900Electrocardiographic findings in Anderson-Fabry disease versus sarcomeric hypertrophic cardiomyopathy
Authors: Vitale G , Biagini E , Ziacchi M , Di Nicola F , Graziosi M , Ditaranto R , Pasquale F , Berardini A , Tanini I , Lanati G , Foa A , Caponetti G , Leone O , Olivotto I , Rapezzi C
Published: October 2019

Background

Cardiac involvement is one of the most frequent and disabling organ damage in Anderson-Fabry (AF) disease, causing hypertrophic cardiomyopathy (HCM), conduction disturbances, arrhythmias and coronary disease. Differential diagnosis from sarcomeric HCM is often very challenging, especially for patients with exclusive cardiac involvement.

Purpose

To gain new insights from standard electrocardiogram (ECG) in AF disease, and identify ECG differences from sarcomeric HCM.

Methods

Sixty-two consecutive patients (27 males, mean age: 62±16 years) with definite diagnosis of AF disease from 2 Italian centres were evaluated for ECG analysis and divided in 2 groups, according to the presence (Group A, N=39) or the absence (Group B, N=26) of cardiac involvement [hypertrophy detected at echocardiogram or cardiac magnetic resonance (CMR)]. All ECGs were analysed by 2 independent investigators. For Group A, when CMR was performed, a correlation between CMR and ECG was assessed. Patients with cardiac involvement were matched with 78 sarcomeric HCM patients according to sex, age and septal wall thickness on echocardiogram.

Results

Two AF patients out 39 with cardiac involvement (5%) had normal ECG. Short PR and I degree atrio-ventricular (AV) block were both reported in 6 (15%) cases. Twenty-six (67%) patients showed left ventricular hypertrophy and the majority (85%) had abnormal repolarization. CMR was performed in 22 patients (56%); the 11 (50%) patients with replacement fibrosis had a higher mean Sokolow-Lyon score (4.1±1.8 vs 2.9±1.0 mV; p=0.05), more frequent ST segment depression (82 vs 27%; p=0.03) and negative T waves (91 vs 36%; p=0.027; sensitivity: 90%; specificity: 63%), compared with the 11 without replacement fibrosis.

When compared with sarcomeric HCM, AF patients with cardiac involvement had a significantly wider QRS (120±30 vs 100±16 msec; p<0.0001), a higher frequency of right bundle branch block (RBBB) (18 vs 3%; p=0.01), ST segment depression (54 vs 20%; p<0.0001) and negative T waves (72 vs 46%; p=0.01), typically in the inferior leads (44 vs 14%; p<0.0001). No significant differences in terms of pseudo-necrosis and QRS voltages were found.

Among Group B AF patients (26, mean age: 36±12 years), 4 had short PR and 5 incomplete RBBB. Four had an abnormal ECG (1 left atrial enlargement, 2 unspecific repolarization abnormalities, 1 Sokolow score of 3.5 mV).

Conclusions

Standard ECG can detect cardiac involvement in AF disease. A good correlation was reported between repolarization abnormalities and replacement fibrosis on CMR. Wide QRS and RBBB were more frequent among AF patients compared to age-sex-matched sarcomeric HCM ones, probably due to the different aetiology of the diseases (infiltrative disease vs pure hypertrophy).
P901Association between arrhythmias and myocardial mass with the presence of fibrosis in a cohort of patients with Fabry disease
Authors: Ruiz Cueto M , De Frutos Seminario F , Alcoberro Torres L , Codina Verdaguer P , Manito Lorite N , Gonzalez Costello J , Torras Ambros J , Gascon Bayarri J , Diez Lopez C , Cequier Fillat A
Published: October 2019

The presence of myocardial fibrosis is a marker of advanced disease in Fabry disease.

A retrospective, transversal analysis was performed from a unicentric cohort. Clinical, electrical and imaging parameters were tested for their association with fibrosis.

The study population consisted of fifteen patients (mean age 44.8). We found a statistically significant association between fibrosis, indexed myocardial mass and interventricular septum (IVS) thickness. Although not statistically significant, a tendency of association between the fibrosis and age, NT-proBNP, QRS duration, ventricular extrasystolia, supraventricular tachycardia and atrial fibrillation was observed. Ventricular arrhythmias or syncope happened only in patients with fibrosis. T wave depth and QTc duration were not associated with fibrosis.

Myocardial fibrosis in fabry disease Absence of fibrosis (N=6) Fibrosis (N=9) P Age (Years) 51.3 (16.4) 55.8 (12.9) 0.64 Females (%) 3 (50%) 5 (55%) 1 NT-proBNP (ng/L) 294 (374) 1334 (1663) 0.14 IVS thickness (MRI, mm) 13.5 (4.3) 22.8 (10) 0.02 Indexed myocardial mass (echocardiography, g/m2) 108 (39.7) 206 (85.3) 0.03 PR segment duration (mseg) 145 (25.1) 171 (41.8) 0.21 Presence of negative T wave (yes/no) 5 (83%) 8 (89%) 1 Maximum depth of T wave (mV) 6.5 (6.8) 4.2 (3.2) 0.86 QTc duration (mseg) 426 (24) 423 (28) 0.72 QRS duration (mseg) 94.7 (15.3) 113.3 (26.5) 0.11 Supraventricular extrasistolia (number/day) 833 (1413) 769 (871) 0.88 Ventricular extrasistolia (number/day) 280 (605) 1247 (3079) 0.16 Supraventricular tachycardia (yes/no) 0 (0%) 3 (37.5%) 0.23 Atrial fibrillation (yes/no) 1 (17%) 4 (44%) 0.58 Ventricular tachycardia (yes/no) 0 (0%) 2 (22%) 0.49 Sincope (yes/no) 0 (0%) 1 (11%) 1 Results are presented as average and standard deviation for quantitative variables (comparisons with Wilcoxon test) and as a number of patients and proportion for qualitative variables (comparison with Fisher test).

Conclusions

Reduction of fibrosis formation could be a target to prevent the development of arrhythmias in FD. Increased myocardial mass and hypertrophy, derived from glycosphingolipids accumulation, is associated with fibrosis generation; treatments targeting myocardial mass could affect the presence of fibrosis.
P929Predictors of renal function improvement in patients with chronic kidney disease undergoing TAVR
Authors: Lemes M V S , Bacelar A C , Rosa V E E , Caixeta A M , Lemos P A , Ribeiro H B , Almeida B O , Mariani J , Campos C A H M , Tarasoutchi F , Franken M , Brito F S
Published: October 2019

Background

Chronic kidney disease (CKD) is common among patients undergoing transcatheter aortic valve replacement (TAVR). The prognosis of CKD on TAVR outcomes has been previously documented. However, there is a paucity of data about predictors of renal function improvement and its clinical relevance.

Purpose

To determine predictors of renal function improvement after TAVR among patients with CKD.

Methods

Prospective study, analyzing 819 patients from 22 centers with symptomatic severe aortic stenosis included in the Brazilian TAVR Registry between 2008 and 2015. CKD was defined as estimated glomerular filtration rate (eGFR) <60mg/dL, and patients without CKD were excluded. Groups were divided according to variation of eGFR between baseline and 7 days after TAVR: improvement (increase >10% in eGFR) in 197 (34.1%) patients, worsening (decrease >10% in eGFR) in 203 (35.2%), and stable (neither criteria) in 177 (30.7%). Logistic regression analysis was used to identify predictors of renal function improvement. One-year outcomes were determined as Kaplan-Meier survival curves.

Results

CKD was present in 577 (70%) patients. The mean age was 81.9±6.8 years, 56.2% were male, 31.7% had diabetes and 74.5% had hypertension. The mean STS score was 10.6±7.9%, the mean EuroSCORE II were 21.8±15.2% and the preferable access site was transfemoral (93.4%). The mean eGFR was 37.3±12.5 ml/min in the improvement group (IG), 39.6±11.7 ml/min in the stable group (SG) and 40.2±12.3 ml/min in the worsening group (WG), with significant statistical difference between IG and WG (p=0.044). There was no difference related to contrast midia volume between the 3 groups. In the multivariate analysis, coronary artery disease (OR: 0.69; 95% CI 0.48–0.98; p=0.039) and baseline eGFR (OR: 0.98; 95% CI 0.97–1.00; p=0.039) were associated with improvement in renal function. There was no significant difference in 1-year all-cause mortality between IG and SG (15.4 vs 9.5%, log rank p=0.141) (Figure 1A). However, the WG had higher mortality compared with the IG (29.3 vs 15.4%, log rank p<0,001) (Figure 1B).

Figure 1

Conclusion

Improvement in renal function after TAVR was frequently found among patients with CKD. The absence of coronary artery disease and lower baseline eGFR were independent predictors of improvement in renal function. Although the IG had lower 1-year all-cause mortality compared to WG, no difference were observed related to SG.

Acknowledgement/Funding

SBHCI
P938Extensive formation of atherosclerotic cardiovascular disease in subjects with severe familial hypercholesterolemia defined by the international atherosclerosis society criteria
Authors: Funabashi S , Kataoka Y , Harada-Shiba M , Hori M , Doi T , Ogura M , Hirayama A , Nishikawa R , Tsuda K , Noguchi T , Yasuda S
Published: October 2019

Introduction

The International Atherosclerosis Society (IAS) has proposed “severe familial hypercholesterolemia (FH)” as a FH phenotype with the highest cardiovascular risk. Coronary artery disease (CAD) represents a major atherosclerotic change in FH patients. Given their higher LDL-C level and atherogenic clinical features, more extensive formation of atherosclerosis cardiovascular disease including not only CAD but stroke/peripheral artery disease (PAD) may more frequently occur in severe FH.

Methods

481 clinically-diagnosed heterozygous FH subjects were analyzed. Severe FH was defined as untreated LDL-C>10.3 mmol/l, LDL-C>8.0 mmol/l+ 1 high-risk feature, LDL-C>4.9 mmol/l + 2 high-risk features or presence of clinical ASCVD according to IAS proposed statement. Cardiac (cardiac death and ACS) and non-cardiac (stroke and peripheral artery disease) events were compared in severe and non-severe FH subjects.

Results

Severe FH was identified in 50.1% of study subjects. They exhibit increased levels of LDL-C and Lipoprotein (a) with a higher frequency of LDLR mutation. Furthermore, a proportion of %LDL-C reduction>50% was greater in severe FH under more lipid-lowering therapy (Table). However, during the observational period (median=6.3 years), severe FH was associated with a 5.9-fold (95% CI, 2.05–25.2; p=0.004) and 5.8-fold (95% CI, 2.02–24.7; p=0.004) greater likelihood of experiencing cardiac-death/ACS and stroke/PAD, respectively (picture). Multivariate analysis demonstrated severe FH as an independent predictor of both cardiac-death/ACS (hazard ratio=3.39, 95% CI=1.12–14.7, p=0.02) and stroke/PAD (hazard ratio=3.38, 95% CI=1.16–14.3, p=0.02) events.

Clinical characteristics of severe FH Non-severe FH Severe FH P-value Baseline LDL-C (mmol/l) 5.3±1.5 6.6±2.0 <0.0001 Lp(a) (mg/dl) 15 [8–28] 21 [10–49] <0.0001 LDLR mutation (%) 49.6% 58.9% 0.00398 On-treatment LDL-C (mmol) 133 [106–165] 135 [103–169] 0.9856 %LDL-C reduction>50% 21.3% 49.8% <0.0001 High-intensity statin (%) 13.3% 42.3% <0.0001 PCSK9 inhibitor (%) 6.3% 21.2% <0.0001

Clinical outcome

Conclusions

Severe FH subjects exhibit substantial atherosclerotic risks for coronary, carotid and peripheral arteries despite lipid lowering therapy. Our finding underscore the screening of systemic arteries and the adoption of further stringent lipid management in severe FH patients.
P948Rapid and automated risk stratification by determination of aortic stiffness in healthy and cardiovascular diseased
Authors: Rammos C , Halfmann L , Lortz J , Steinmetz M , Janosi A , Rassaf T
Published: October 2019

Background and aims

Aortic stiffness is an independent predictor of cardiovascular morbidity and mortality and thus simple, rapid and preferably automated techniques are indispensableto persue a global approach in risk statification. A novel oscillometric based carotido-femoral pulse-wave velocity (cfPWV) was investigated, regarding diagnostic accuracy, sensitivity and specificity and with emphasis on costs, training curves and procedural time effort.

Methods

In a single-center crossover study, we evaluated subjects free of known cardiovascular disease (CVD) and CVD subjects and a subgroup with peripheral artery disease (PAD) undergoing ankle-brachial index (ABI) and PWV measurements using oscillometry (BoSo, Bosch + Sohn, Germany) compared to tonometry (SphymoCor, Atcor Australia). Pearson's correlation analysis was used to assess the relationship of PWV measurements for both methods. Moreover, examination times and costs were compared.

Results

A total of 174 study subjects underwent assessment of oscillometric and tonometric PWV measurements. CVD-free subjects (n=57) were younger (60.4±15.6 vs. 67±12.9 years, p=0.003) compared to CVD subjects (n=117). PWV measurements showed significant correlations in CVD-free subjects (r=0.797, p<0.001), in CVD subjects (r=0.817, p<0.001) and the subgroup of PAD subjects (r=0.807, p<0.001). Sensitivity, specificity, positive predictive value and negative predictive value of the oscillometric measurement for detecting arterial stiffness reached 93%, 84%, 86%, and 92%. The examination time of the oscillometric method was shorter compared to tonometry (4.4±0.5 vs. 9.2±0.8 min, p<0.001) in line with reduced costs.

Conclusion

Using a simple and rapid automated oscillometric method, we provide good diagnostic accuracy for the determination of aortic stiffness through PWV, both in CVD-free and in CVD subjects. This might help in terms of cost-effectiveness and simplification in daily practice to screen for cardiovascular morbidity and for vascular damage in atherosclerosis.
P954Value of a single bolus erythopoetin in STEMI patients treated with the Genous endothelial progenitor cell capture stent
Authors: Camaro C , Suryapranata H , Ottervanger J P , Dambrink J H E , Gosselink M , Zijlstra F , De Boer M J
Published: October 2019

Background

The Endothelial Progenitor Cell (EPC) stent was designed to capture circulating EPCs and promote early stent re-endothelization. Erythropoietin (EPO) stimulates mobilization of EPC from the bone marrow. Combination of EPO and the EPC stent in the setting of ST-segment elevation myocardial infarction (STEMI) has never been investigated.

Methods

STEMI patients enrolled in the HEBE-III trial were randomized to a single bolus of EPO or No-EPO after implantation of the EPC capture stent. Late lumen loss (LLL) was determined at 9-month angiographic follow-up. Clinical data was collected at 30 days and 12 months.

Results

196 patients were randomized to EPO (n=100) or No-EPO (n=96). No significant difference in baseline characteristics was observed between the two groups. A significant reduction in angiographic LLL was observed with EPO (0.43±0.57mm) as compared to No-EPO (0.74±0.63mm) (p=0.011). At 12 months follow up, no difference with regard to death or re- infarction was observed in both groups, whereas significant reduction in the need for target vessel revacularization for the EPO versus No-EPO was observed with rates of 7.1% and 19.1% respectively (p=0.013).

Angiographic and clinical results EPO (n=39) No-EPO (n=45) P-value Angiography   Lume late loss 0.43±0.57 0.74±0.63 0.011 12 months clinical   Death 0 0 ns   Re infarction 0 1 (2.2%) ns   Additional PCI 4 (10.3%) 17 (37.8%) 0.004   CABG 2 (5.1%) 2 (4.4%) ns   CVA 0 0 ns   Bleeding 3 (7.7%) 4 (8.9%) ns ns = not significant; CVA = cerebrovascular accident; CABG = coronary bypass graft; PCI = percutaneous coronary intervention.

Conclusion

In STEMI patients treated with EPC capture stent, additional EPO can further improve angiographic LLL
P960Association of peri-procedural intravenous morphine use on clinical outcomes in ST-elevation myocardial infarction treated by percutaneous coronary intervention: systematic review and meta-analysis
Authors: Batchelor R , Liu D , Bloom J , Noaman S , Chan W
Published: October 2019

Background

Morphine analgesia may affect absorption of co-prescribed P2Y12 antagonists attenuating platelet inhibition. The impact of peri-procedural intravenous (IV) morphine administration on clinical outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) is not well defined.

Purpose

To conduct a systematic review and meta-analysis exploring clinical outcomes with peri-procedural IV morphine in patients undergoing PPCI for STEMI.

Methods

Analysis of the electronic databases MEDLINE, EMBASE, CENTRAL, Scopus, Web of Science and ClinicalTrials.gov for association of peri-PCI IV morphine use with myocardial infarction (MI) and mortality. Primary and secondary outcomes were in-hospital or 30-day MI and all-cause mortality respectively.

Results

Eleven studies (1 randomised controlled trial; 10 cohort studies) were included for systematic review. Five studies, including 3,748 patients were included in meta-analysis of the primary outcome. Of 3,748 patients, 2,239 were treated concurrently with ticagrelor, 1,256 treated with clopidogrel and 253 with prasugrel. As shown in the Figure, there was a trend towards increased risk of myocardial infarction with IV morphine (odds ratio 1.88; 95% CI 0.87–4.09, I2 0%). Across seven studies and 6585 patients, no increased risk of mortality at the same composite time endpoint was evident (odds ratio 0.70, 95% CI 0.40–1.23, I2 19%).

Figure 1. MI in hospital or at 30 days

Conclusion

Based on current literature, evidence of an association between IV morphine and myocardial infarction in patients undergoing PPCI for STEMI is limited by observational methodology and conflicting results. There is no evidence of an association between intravenous peri-procedural morphine and mortality. Clinical trial evidence with strong documentation of adverse events data is required to demonstrate association or causality.

Acknowledgement/Funding

None
P970DK-crush is the best treatment strategy to reduce stent oriented clinical outcome, results from a network meta-analysis of twenty-six randomized clinical trials comparing different stent techniques
Authors: Mandurino Mirizzi A , Crimi G , Gritti V , Scotti V , Strozzi C , Silvestri A , Montalto C , D'Ascenzo F , Repetto A , Ferlini M , Marinoni B , De Servi S , Ferrario M , Klersy C , Oltrona Visconti L
Published: October 2019

Background

Coronary bifurcation disease (CBD) accounts for approximately 20% of all and is associated with worse short- and long- term clinical outcomes. Provisional stenting (PS) is the preferred choice, however, this approach may not be suitable in all CBD anatomies, therefore several elective two-stents techniques have been described, however there is lack of randomized evidence to guide interventionalist across different stent techniques. Objectives. To identify the best percutaneous coronary interventions (PCI) technique for CBD.

Methods

We systematically review randomized clinical (RCTs) of patients receiving CBD PCI with either PS or six type of elective two-stent techniques (DK-crush, TAP, culotte, dedicated bifurcation stents, crushing, T-stenting) and compare device oriented clinical events (DOCE) in a network meta-analysis. DOCE was defined as composite of cardiac death, target-vessel myocardial infarction, stent thrombosis, target lesion revascularization OR target vessel revascularisation.

Results

We included 26 RCTs leading to a pooled population of 10339 patients-years with 1229 DOCE. Compared to PS, the DK-crush technique had a lower DOCE with RR=0.62, [0.42–0.92]. Figure. DK-crush had the highest likelihood (model likelihood=90.2%, SUCRA=98.0%) of being the best treatment to reduce DOCE.

Figure 1

Conclusions

In the management CBD, when a two-stent technique is required as upfront strategy, the DK- Crush technique should be privileged as it showed to reduce stent-related clinical outcomes (DOCE) when compared to other bifurcation techniques.
P987Dilated cardiomyopathy - a group that does not benefit from ICD?
Authors: Silverio Antonio P , Nunes-Ferreira A , Aguiar-Ricardo I , Rigueira J , Santos R , Rodrigues T , Cunha N , S Morais P , Couto Pereira S , J Pinto F , De Sousa J , Marques P
Published: October 2019

Introduction

The prevalence of sudden death in patients with heart failure with reduced ejection fraction has been declining in the last decade, not only due to better optimization of pharmacological therapy, but also due to the high rate of cardiac resynchronization responders. Overall, based on recent studies demonstrating a lack of improvement in mortality in some patients with dilated cardiomyopathy, the CRT-P/CRT-D implantation ratio has been increasing across Europe.

Objective

To evaluate the evolution of the CRT-P/CRT-D implantation ratio and to evaluate the impact on mortality of dilated cardiomyopathy (DCM) patients who underwent resynchronization therapy.

Methods

A single-center prospective study of non-randomized patients who underwent CRT implantation since 2015. Demographic and clinical data from patients with dilated cardiomyopathy were assessed. The mortality of these patients and the predictors of mortality by the Cox and Kaplan-Meier regression method were evaluated.

Results

486 CRTs were implanted since 2015 (male 73.9%, age 72.06±9.9 years, median follow-up time of 487 days IIQ [175, 749].) During the last 3 years, occurred an increased in CRT-P/CRT-D ratio with the CRT-P implant rate increasing from 36% of the total devices in 2015 to 47% in 2018. Of the patients submitted to CRT implantation, 256 (55%) had dilated cardiomyopathy as the etiology of heart failure. In this population, by multivariate Cox analysis, age (HR 1.1, 95% CI 1.0–1.1, p=0.003) and GFR <60ml/min/1.73m2 (HR 1.8 IC 95% 1, 2–2.6, p=0.01) were independent predictors of mortality. In addition, CRT-D implantation in these patients was associated with a significant reduction in all-cause mortality (HR 0.33 95% CI 0.15–0.73, p<0.01) with a required number to treat only 10 patients. Similar results were obtained in the subgroup of patients aged ≥59 years.

Mortality in DMC – CRT-P vs CRT-D

Conclusion

The CRT-P implant rate has been increasing at the expense of the CRT-D implant after some studies suggest no benefit in the population aged ≥59 years. However, in our population of patients with DCM, CRT-D implantation demonstrated a 67% mortality reduction. These results may demonstrate a good selection of patients for this therapy, but should also motivate further studies in the evaluation of mortality in this subgroup of patients.