bluuebunny/crossref_metadata_2025 huggingface dataset:
P332Comparative efficacy of intracoronary agents for acute treatment of coronary no-reflow: a network meta-analysis
Authors: Stibleichinger M , Wendt J , Hofbauer F , Klappacher G
Published: October 2019

Background

Coronary no-reflow is a potentially lethal complication of percutaneous coronary intervention (PCI). There is a growing body of evidence on how to best prevent this condition by the proper stenting technique and other mechanical measures or adjunctive drug treatments. However, it is still controversial how to tackle coronary no-reflow when it occurs.

Purpose

We aimed to compare and rank intracoronary agents for acute treatment of coronary no-reflow by considering both indirect and direct evidence from the literature in a network meta-analysis.

Methods

We searched the databases PubMed, Embase and Central for randomised controlled trials of the acute treatment of coronary no-reflow following primary PCI in patients with ST-elevation myocardial infarction (STEMI) and non-STEMI. Trials with patients suffering from stable angina and/or receiving elective PCI, observational study design and no measure of coronary flow were excluded. Two blinded reviewers independently collected studies, assessed risk of bias with the Cochrane risk of bias tool and extracted data. The primary outcome was a measure of coronary flow immediately following the intervention (TIMI flow grade, TIMI frame count or myocardial bush grade), secondary outcome were major adverse cardiovascular events during follow-up. Pairwise and network meta-analysis were performed using the random-effects model within a frequentist framework.

Results

8 studies with a total of 540 participants were identified, including 4 multi-arm studies. This enabled 19 pairwise comparisons of 12 different treatments, all administered via intracoronary route (ADE=adenosine, DIL=diltiazem, DIP=dipyridamole, NIT= nitroglycerin, NPR=nitroprusside, PLA=placebo, TIR=tirofiban, U+V=urokinase combined with verapamil, URA=urapidil, URO=urokinase, VER=verapamil X+T= Xuesaitong combined with tirofiban). Overall, risk of bias in these studies was rated moderate. For graphical representation of the network for the primary outcome, see left panel of the figure. It exhibited a low level of inconsistency and heterogeneity with a global I2 value of 20.9%. Among the different treatments, URA, X+T, and TIR were more effective in re-establishing coronary flow with the caveat that the results of URA depended on one singular trail with a large variance, see right panel of the figure. NIT was even slightly worse than placebo in the primary outcome, the other agents were equivalent with placebo. In terms of major cardiovascular events during follow-up, TIR exhibited a protective effect compared with placebo at borderline statistical significance (OR 0.3843 [95% CI 0.1488; 0.9923]. For URA, data on secondary outcome were not available.

Conclusions

Urapidil and Tirofiban are potentially effective candidate drugs for larger randomised controlled trials, which are needed to validate the sparse evidence that is available to date on the acute treatment of coronary no-reflow.
P337Natural history, reversibility and arrhythmias associated with truncating titin variants in dilated cardiomyopathy
Authors: Vissing C R , Rasmussen T B , Olesen M S , Pedersen L N , Dybro A , Bundgaard H , Jensen M , Christensen A H
Published: October 2019

Background

Truncating genetic variants in titin (TTNtv) are identified in 15–25% of patients with primary dilated cardiomyopathy (DCM). Previous genotype/phenotype studies have reported conflicting results regarding disease severity and pathologic features associated with TTNtv.

Purpose

To investigate the natural history, reversibility and burden of arrhythmias associated with TTNtv in a Danish cohort with long-term follow-up.

Methods

Patients with DCM, recruited from two Danish tertiary centers, were included based on the presence of a TTNtv in a cardiac expressed titin exon. Data on patients' medical history including symptoms, demography, family history, comorbidities, treatment, ECG features, and echocardiograms were registered. Outcome data including all-cause mortality, need of heart transplantation (HTX) or left ventricular assist device (LVAD), and presence of ventricular and supraventricular arrhythmias were registered. Left ventricular reverse remodeling (LVRR) was defined as an absolute increase in left ventricular ejection fraction (LVEF) ≥10% points or normalization.

Results

A total of 104 patients (71 men, 69%; 72 probands) with definite TTNtv-DCM were included. The mean age at DCM diagnosis was (mean±SD) 45±13 years (43±13 for men; 49±14 for women, p<0.04) and median follow-up was 8.1 years. The mean LVEF was 28±13% at time of diagnosis (26±12% for men; 30±13% for women, p=0.173). During follow-up, 31 patients (30%; 24 men) died or needed HTX/LVAD. Medical therapy was associated with LVRR in 79% of patients 3.6 years after diagnosis. LVRR was maintained long-term in 64% of patients. Women had a better response to medical therapy compared to men (mean LVEF increase 19%; vs 15% in men, p<0.04). Atrial fibrillation/flutter was observed in 40% of patients and ventricular arrhythmias in 23% of patients. Men had an earlier occurrence of both supraventricular and ventricular arrhythmias (p=0.005) with half of the men having experienced an arrhythmia at the age of 54 years.

Freedom from arrhythmias with age

Conclusion

TTNtv leads to a DCM phenotype associated with a marked gender-difference in age at DCM diagnosis and high burden of both supraventricular and ventricular arrhythmias. Importantly, the DCM-TTNtv phenotype was associated with a high degree of reversibility of systolic function following medical therapy.
P340Inflammatory cardiomyopathy in Fabry disease
Authors: Bicho Augusto J A , Nordin S , Kozor R , Vijapurapu R , Knott K , Ramaswami U , Geberhiwot T D , Steeds R P , Baig S , Hughes D , Moon J C
Published: October 2019

Background

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in α-galactosidase A. Cardiovascular magnetic resonance (CMR) has helped unveil the pathogenesis of Fabry cardiomyopathy: sphingolipid storage (low T1 mapping values), left ventricular hypertrophy (LVH) and myocardial fibrosis with late gadolinium enhancement (LGE) characteristically present in the basal inferolateral (BIFL) wall. Recent evidence has suggested that the LGE may be inflammation and oedema as part of this pathogenic process.

Purpose

To assess the presence of inflammation in patients with FD using T2 mapping (for oedema/inflammation) supported by blood troponin levels (showing myocyte death and by inference inflammation).

Methods

A multi-centre international study in gene positive FD patients using CMR and blood biomarkers. All participants underwent CMR at 1.5 T. Native T1 and T2 mapping were performed. The T1 mapping sequence was MOLLI with sampling scheme in seconds. LGE used a phase sensitive inversion recovery sequence. Global longitudinal 2D strain (GLS) values were obtained using feature tracking analysis. Blood high-sensitivity troponin T (hsTnT) was measured on the same day.

Results

100 FD patients (age 43.8±1.3 years, 42% male) were included. 45% had LVH, 35% LGE. Low T1 mapping (normal <943ms) was found in 49% and 33% had high hsTnT values (normal <15ng/L). Mean T2 mapping values were 52.6±0.6ms in the BIFL wall and 49.5±0.3ms in the remote myocardium/septum (p<0.001, normal <53ms). T2 values in the BIFL wall were significantly higher among patients with LGE (58.2±6.1ms vs 49.2±3.1ms, p<0.001, Figure 1). In a per-segment analysis of 1600 segments, higher T2 values correlated positively with percentage of LGE per segment (r=0,262, p<0.001), T1 values (r=0,205, p<0.001), maximum wall thickness (r=0,253, p<0.001) and GLS values (r=0,212, p<0.001). HsTnT values were higher among patients with LGE (median of 31 vs 3ng/L in patients without LGE, p<0.001). There was a strong positive correlation between T2 values in the BIFL wall and ln(hsTnT) (r=0.776, p<0.001, Figure 2). The strongest predictor of increased hsTnT in multivariate analysis (age, sex, LVH, septum T1, T2 in the BIFL, GLS, LGE) was T2 in the BIFL wall (β=0.4, p=0.001).

Conclusions

Cardiac involvement in FD goes beyond storage (low T1 values). When LGE is present, this is almost always associated with a high T2 and troponin elevation supporting FD as a chronic inflammatory cardiomyopathy. Initial reports of LGE being fibrosis are too simplistic – LGE in FD appears to have a significant chronic inflammation/oedema component.
P345Catheter ablation for atrial fibrillation is associated with lower incidence of stroke, major bleeding and death: data from Korean health registries
Authors: Joung B , Yang P S , Sung J H , Jang E S , Yu H T , Kim T H , Pak H N , Lee M H
Published: October 2019

Background

Compared with antiarrhythmic drug therapy, catheter ablation of AF reduces the number of AF episodes, prolongs the time in sinus rhythm, and improves quality of life. However, it is still unclear if catheter ablation for atrial fibrillation (AF) affects the prognosis or merely is a symptomatic treatment. Our objective was to compare long-term outcome regarding stroke, major bleeding and death in AF patients with and without ablation, and in relation to long-term exposure to anticoagulants.

Methods

We identified all 800,084 patients with a diagnosis of AF from 2006 to 2015 in the Korean national health insurance service database. During a 10-year period, 10,979 AF ablations were performed among 9,768 individuals. Propensity scores for the likelihood of AF ablation were obtained by logistic regression. Propensity score (PS) matching was used to construct two cohorts of equal size (n=9,768) with similar characteristics in 16 dimensions.

Results

Patients who had undergone catheter ablation were younger (57.2 vs. 65.6 years, P<0.001) and healthier (mean CHA2DS2-VASc scores 2.5±1.7 vs. 3.6±2.1, P<0.001) than other patients with AF. Mean follow-up was 5.5±3.1 years. After propensity score matching, in the ablated group, 472 patients suffered ischemic stroke/systemic embolism (SE) compared with 1,682 in the matched non-ablated (annual rates 2.92 vs. 1.10%, P<0.001). Major bleeding occurred in 439 and 1,219 patients in ablated and non-ablated (annual rates 2.07 vs. 1.01%, P<0.001). A total of 306 ablated and 1,439 non-ablated patients died (annual rates 2.31 vs. 0.69%, P<0.001). After multivariable adjustments, catheter ablation was associated with lower risk of ischemic stroke [hazard ratio (HR) 0.51, 95% confidence interval (CI) 0.38–0.67), lower risk of major bleeding (HR 0.65, 95% CI 0.57–0.75) and with lower mortality risk (HR 0.39, 95% CI 0.34–0.46). The reduction of stroke/SE and mortality was observed after AF ablation regardless thromboembolic risk. Major bleeding was reduced only among patients with CHA2DS2-VASc score ≥2 (HR 0.70, 95% CI 0.59–0.84).

Conclusion

We found a strong association between ablation and survival. Ablation may be associated with lower incidence of ischemic stroke and major bleeding in patients with AF. The reduction of stroke/SE and mortality was observed regardless thromboembolic risk after AF ablation. But the risk of major bleeding was reduced only in patients with high thromboembolic risk factors.
P574Accuracy of wrist-worn heart rate monitors for chronotropic assessment in atrial fibrillation
Authors: Al-Kaisey A , Koshy A , Ha F J , Sajeev J , Toner L , Spencer R , Teh A , Farouque O , Lim H S
Published: October 2019

Introduction

Wrist-worn fitness and heart rate (HR) monitors are increasingly popular. Previous studies in healthy participants with sinus rhythm (SR) have yielded variable results depending on HR, activity levels and device tested. A paucity of data exists on their accuracy in atrial fibrillation (AF) in ambulatory patients.

Purpose

We sought to assess the HR accuracy of 2 commercially available smart watches (Fitbit Charge HR [FB] and Apple Watch Series 3 [AW]) compared with Holter monitoring in an ambulant patient cohort.

Methods

Patients aged >18 years referred for 24-hour Holter monitoring were prospectively recruited. The Holter monitor was the criterion measure. Each patient was randomly allocated to either a FB or AW along with their Holter monitor. The study protocol was approved by the institutional review board.

Statistical analysis: Pearson (r) correlation coefficients and Bland-Altman comparison with 95% limits of agreement (LoA) were evaluated to assess criterion validity and agreement between the smart watch and Holter ECG-HR. Bias was the calculated mean difference between the smart watch and ECG-HR. A ± 10-beat different between Holter-HR and SW-HR was used as a clinically relevant range to establish the accuracy of HR estimation by SW.

Results

Across all devices, 53,288 hear rate values were recorded from 32 patients. Twenty six patients were in persistent AF and six were in SR. Twelve patients wore the FB while 20 wore the AW. In the FB arm, nice patient were in persistent AF and three in SR. In the AW arm, persistent AF was the rhythm in seventeen and SR in three. Patients in SR demonstrated overall strong agreement compared to Holter monitoring (Mean Bias <1 beat, LoA −11 to 11 beats) and a correlation coefficient of 0.87 (p<0.001). In AF, both devices underestimated HR measurements (Overall Bias −9 beats, LoA −41 to 23, r=0.60, p<0.001). The AW had lower bias and narrower LoA compared to FB (−5 beats vs −13 beats, LoA −31 to 21 beats vs −50 to 22 beats). Using a ± 10-beat range against ECG-HR for clinical accuracy, both the AW and FB performed satisfactorily in SR with 95.2% of AW and 92.2% of FB HR readings considered valid. In AF, however, the AW-HR readings were within the ± 10-beat threshold in 76.5% of the time compared with only 56.1% of FB readings.

Conclusion

In ambulatory patients, smart watches were accurate in HR estimation when compared to Holter monitor in SR; however tended to underestimate HR in AF. Further improvements in device technology are needed before the widespread consumer adoption of this nascent technology for chronotropic assessment in arrhythmias.
P586Left ventricular volume and mass adaptation after 58-days head-down bed-rest assessed by cine-MRI, and effectiveness of high-intensity jump training countermeasure
Authors: Egoriti R , Landreani F , Costantini L , Mulder E , Gerlach D , Vaida P , Migeotte P.-F , Caiani E G
Published: October 2019

Aims

Prolonged immobilization generates cardiac deconditioning, a risk factor for cardiovascular disease, and efficient countermeasures (CM) are needed to prevent it. Our aim was to assess by Cine-MRI the effects of long-term strict head-down (−6 degrees) bed-rest (BR) deconditioning, and the effectiveness of high-intensity jump training CM, on left ventricular (LV) function and mass.

Methods

23 male participants (29±6 years, 181±6 cm, 77±7 kg) were enrolled. The experiment was conducted at: envihab (Koln, DLR, Germany) as part of the European Space Agency BR studies. Volunteers were randomly allocated to the jump training group (JUMP, n=12) or the control group (CTRL, n=11). A typical training session consisted of 4x10 countermovement jumps and 2x10 hops in a sledge jump system, with 5–6 sessions per week.

Steady-state free precession cine-MRI images were obtained (25 frames/cardiac cycle, 8mm thickness, no gap, no overlap) as stack of short-axis images covering the whole LV from base to apex, before (PRE) and after 58-days (HDT58) of BR. Endocardial and epicardial semi-automated contouring was performed using custom software.

Results

In CTRL group, at HDT58 a reduction in LV mass (9%), end-diastolic (21%), end-systolic (8%) and stroke volume (23%) were observed, while ejection fraction did not change. In JUMP group, the reduction in LV end-diastolic volume was only by 9%, followed by a decrease in end-systolic (10%) and stroke volume (10%), with a preservation of LV mass. In both groups, ejection fraction did not change.

Left ventricular changes after 58d BR EDV (ml) ESV (ml) SV (ml) EF (%) Mass (g) CTRL PRE 171 (163; 191) 60 (58; 65) 113 (102; 124) 64 (63; 67) 133 (121; 160) HDT58 143 (131; 149)* 56 (50; 58)* 86 (83; 92)* 62 (60; 63)* 127 (106; 138)* JUMP PRE 156 (140; 204) 70 (61; 84) 91 (78; 117) 58 (56; 60) 118 (104; 134) HDT58 141 (135; 175)* 63 (54; 69)* 90 (78; 92)* 58 (55; 60) 113 (105; 128) Results expressed as median (25th; 75th percentiles). *p<0.05 Wilcoxon non parametric paired test (PRE vs HDT58). CTRL: control group; JUMP: countermeasure group.

Conclusions

Cardiac adaptation to deconditioning due to immobilization induced by BR resulted in a reduction of cardiac volumes and function, together with a decrease in LV mass. Interestingly, the applied JUMP countermeasure appeared able to partially reverse these effects, in particular by reducing the decrease in end-diastolic volume and preserving LV mass. This information could be useful for better understanding physiologic changes in patients undergoing long periods of immobilization, as well as to apply the studied countermeasure during space flight to reduce cardiac deconditioning.

Acknowledgement/Funding

Italian Space Agency (contract 2018-7-U.0),CNES/DAR 48ehz747.01950965,BELSPO, via the European Space Agency PRODEX program (PEA 4000110826)
P5874D Flow cardiac magnetic resonance quantification of mitral regurgitation, comparison with transthoracic echocardiography
Authors: Ribeyrolles S , Monin J L , Rohnean A , Diakov C , Caussin C , Sarran A , Paul J F
Published: October 2019

Background

Mitral valve regurgitation (MR) is currently primarily assessed by a multiparametric approach with transthoracic echocardiography (TTE) that can be further completed by 2D Cardiac Magnetic Resonance (2D CMR) in case of doubt or poor acoustic window. TTE and 2D CMR have nevertheless imperfect agreement in terms of MR quantification. Time-resolved phase-contrast cardiac magnetic resonance imaging with flow-encoding in three spatial directions (4D Flow CMR) could help in MR quantification.

Purpose

Compare 4D Flow CMR quantification of MR with TTE using a multiparametric approach.

Methods

We conducted a monocentric, prospective study at the Institut Mutualiste Montsouris in Paris between November 2016 and 2017 including patients with chronic primitive MR. MR was evaluated with a multiparametric approach by two cardiologists with TTE and quantitatively by two radiologists with 4D Flow CMR. MR was classified as mild, moderate or severe and evaluated blindly with consensus in case of disagreement. 4D Flow CMR measurements consisted in quantifying MR regurgitant volume (RV) and MR regurgitant fraction (RF). 4D anterograde mitral flow was compared to left ventricular stroke volume using 2D-cine CMR.

Results

33 patients were included. Inter-observer agreement was good in TTE (kappa= 0.75 95% CI [0.57- 0.92]) and excellent in 4D Flow CMR (ICC= 0.94 95% CI [0.79–0.95]). Agreement with TTE was excellent using optimized thresholds (Mild: RV≤20mL RF≤20%, Moderate: RV=21–39mL RF=21–36%, Severe: RV≥40mL RF≥37%): kappa= 0.93 95% CI [0.8–1] for RV and kappa= 0.90 95% CI [0.7–0.9] for RF. A validation cohort confirmed that the 4D flow thresholds as determined were accurate for MR grading. Agreement between 4D anterograde mitral flow and 2D-cine CMR left ventricular stroke volume was also excellent (ICC= 0.92 95% CI [0.85–0.96]).

Conclusion

4D Flow CMR is a reliable tool for MR quantification. It provides direct quantitative evaluation of MR with low inter-observer variability. It may therefore be used as a gatekeeper before therapeutic decisions such as surgery.
P595Characteristics of the right ventricle in patients with nonischemic dilated cardiomyopathy
Authors: Becker M , Allaart C P , Wubben M , Cornel J H , Van Rossum A C , Germans T
Published: October 2019

Background

In nonischemic dilated cardiomyopathy (DCM), diagnosis and prognosis is based on left ventricular function. Although concomitant right ventricular (RV) dysfunction is frequently observed, the underlying mechanism is currently not fully understood.

Purpose

We aimed to describe the characteristics of right ventricular function in DCM patients with cardiac magnetic resonance (CMR) imaging using cine and late-gadolinium enhancement (LGE) imaging.

Methods

Patients with DCM and left ventricular (LV) dysfunction (ejection fraction (EF) <50%) on LGE-CMR were included prospectively. LV and RV volumes and function were quantified and RV systolic dysfunction was defined as RV ejection fraction (RVEF)<45%. The presence and pattern of LGE were assessed visually and the extent was quantified using the full-width half maximum method. Septal midmyocardial LGE pattern was defined as midwall striae or hinge-point myocardial hyperenhancement. Moreover, left atrial (LA) volumes were calculated using the bi-plane area-length method.

Results

The study included 214 DCM patients (42% female, age 58±14 years) with a mean LVEF of 34±12% and RVEF of 46±12%. RV systolic dysfunction was present in 39% and was associated with the presence of septal midwall LGE (OR 1.96 (95% CI 1.09–3.54) p=0.026). In patients with RV dysfunction, LV dilation was more severe (LV end diastolic volume (EDV) 242±97mL vs. 212±58mL, p=0.011) and LVEF was lowere (26±12% vs. 39±8%, p<0.001) (figure A). There was a weak correlation between septal LGE amount and LVEDV and RVEDV (respectively r=0.36, p=0.003 and r=0.35, p=0.005)

In patients with RV dysfunction, left atrial volumes were enlarged (56±23mL/m2 vs. 46±14mL/m2, p<0.001) and LA emptying fraction was moderately correlated to RVEF (figure B), also after exclusion of patients with a history of atrial fibrillation.

RVEF in DCM patients

Conclusion

In DCM, reduced RVEF predominantly occurred in patients with a) LVEF lower than 30%, b) septal midwall enhancement, indicating progressive LV remodeling, c) LA dilation and d) LA dysfunction. This suggests that RV dysfunction in advanced DCM is drive by LV diastolic dysfunction resulting in increased afterload of the RV.
P597Clinical and prognostic correlates of volume/time curve at cardiac magnetic resonance in patients with non-ischemic heart failure and left bundle branch block
Authors: Aimo A , Barison A , Valleggi A , Salerni S , De Caterina R , Emdin M , Aquaro G D
Published: October 2019

Background

In patients with non-ischaemic systolic heart failure (HF) and left bundle branch block (LBBB), the systolic phase of the left ventricular (LV) volume/time (V/t) curve at cardiac magnetic resonance (CMR) can display a wide or a narrow pattern (WP/NP). The clinical and prognostic significance of these patterns are currently unknown.

Methods

Consecutive patients with systolic non-ischaemic HF (LV ejection fraction <50%) and LBBB were enrolled. They underwent a baseline evaluation including CMR, and were periodically re-evaluated during follow-up. The endpoint was a composite of cardiovascular death, heart failure (HF)-related event, and ventricular arrhythmias requiring defibrillator shock.

Results

Out of 101 patients (mean age 64±11 years, males 50%), NP was found in 29 and WP in 72, with no difference in QRS duration. Patients with WP had worse clinical presentation and greater LV volumes, but similar LGE prevalence, extent or distribution. The WP subgroup displayed a greater maximal dyssynchrony time, expressed both as absolute duration (192±80 vs. 143±65 ms, P<0.001), and as percentage of the RR interval (25±11% vs. 8±4%, p<0.001). Even the systolic dyssynchrony index was higher in patients with WP (13±4 vs. 7±3%, p<0.001). The contractility index was lower in patients with the WP (2.6±1.2 vs 3.2±1.7, p<0.05). Over a median follow-up duration of 44 months (interquartile interval 23–59), only WP (p=0.029) and NT-proBNP (p=0.004) demonstrated an independent prognostic value for cardiac events.

Conclusions

In patients with non-ischaemic systolic HF and LBBB, the WP of V/t curves identifies a subgroup of patients with greater LV dyssynchrony, worse clinical conditions and prognosis.
P610The microvascular obstruction and intramyocardial haemorrhage: impact of different reperfusion strategies in primary myocardial infarction
Authors: Vyshlov E , Alekseeva Y A , Usov V , Ryabov V
Published: October 2019

Background

The coronary reperfusion in patients with ST-elevated myocardial infarction (STEMI) is often complicated by reperfusion-ischemic myocardial injury: microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH). Contrast-enhanced cardiac magnetic resonance imaging (MRI) is the best diagnostic method, which allows to assess these phenomena. It is known that in patients with STEMI and primary percutaneous coronary intervention (PCI), the prevalence rates of MVO and IMH are 50–60% and 40–50%, respectively. There is not enough knowledge about the prevalence of these phenomena in patients with pharmaco-invasive strategy.

Purpose

The aim of the study was to evaluate the prevalence of MVO and IMH in patients with primary STEMI and different reperfusion strategies.

Materials and methods

This observational cohort study included 47 patients with primary STEMI within the first 12 hours after the onset of disease. Exclusion criteria: pulmonary edema, cardiogenic shock, creatinine clearance <30 mL/min or dialysis, severe comorbidity, acute psychotic disorders, and inability to undergo or contra-indications for MRI. These patients were divided into 2 groups. Patients of group 1 (n=30) were treated with a pharmaco-invasive strategy. Fibrinolysis was performed in all patients in the pre-hospital setting. Patients of group 2 (n=17) were treated by primary PCI. MRI was performed at day 2 post-STEMI in all patients. Late gadolinium enhancement and T2-weighted IMH imaging for microvascular obstruction and IMH were used.

Results

Patients with primary PCI more often had MVO: 70.5% (n=12) vs. 40% (n=12) in the pharmaco-invasive group (p=0.05). The occurrence of IMH between the groups did not significantly differ: 40% (n=12) in group 1 vs. 64.7% (n=11) in group 2, respectively. The presence of combination of MVO with IMH was observed significantly more often in group of primary PCI: 47% (n=8) vs. 20% (n=6) (p=0.03). The left ventricular ejection fraction was significantly lower in patients with combination of IMH and MVO compared to those without it: 55% (34–66) vs. 62.5% (53–72) (p=0.01).

Conclusion

MVO and IMH were common findings in patients with primary STEMI and different reperfusion strategies and were present in 40% to 70% of patients. The MVO and combination of MVO with IMH occurred significantly more often in the group of primary PCI. The prevalence rates of IMH in patients with different reperfusion strategies did not significantly differ.

ClinicalTrials.gov, identification number is NCT03677466.
P616RV Strain and 3D RV imaging in diagnosis of acute mountain sickness
Authors: Amuthan V , Ananth R V A , Thinlas T , Chosdol R , Rabgais L , Vivek R
Published: October 2019

Introduction

Right Ventricular (RV) strain and 3D RV ejection fraction sensitivity and specificity has made it a practical and reliable test to detect Acute mountain sickness. All previous studies have been done mainly using M Mode and 2D Echo. Hence it was conceived that 3D Echocardiography would be a better option. Regardless of the type of Acute Mountain Sickness (AMS), the echocardiographic evidence is always the same: Severe Pulmonary hypertension. The visual analysis of these abnormalities requires a trained operator. This operator-dependence has promoted the search for a semiautomatic method to reduce limitations of Echocardiography and improve test accuracy

Purpose

The purpose was to study AMS by 3D Echocardiography

Methods and results

Two dimensional echocardiography with RV strain analysis by speckle tracking echocardiography along with 3D RV ejection fraction was done in nine patients with AMS who were tourists on unplanned, unacclimatized assent to Pangong lake, situated near Leh-Ladakh in the Himalayas, approximately at the height of 4350 meters above sea level and six highlanders, living in Leh-Ladakh. Figure 1A shows the map of the Pangong Lake, B. Shows features of Acute Pulmonary Edema in the Chest X-ray from a patient with AMS, C. Shows the TAPSE (Tricuspid Annular Plane Systolic Excursion) D. Shows the Speckle tracking derived RV Free Wall strain (From a software made for LV) and E: Methodology to derive 3D RV Ejection Fraction. 3D Echocardiographic Equipment with LV strain (which was modified to derive RV Free wall strain) and 3D RV Ejection Fraction software was used for acquisition of images and offline analysis was done. TAPSE, FAC, RV Free wall strain, RV EDV index, RV ESV index and 3D RV EF were consistently lower in patients with AMS than in persons living in high altitude (High landers) Table 1

Results Age Sex M/F Diabetes/ Hypertension TAPSE (mm) FAC RVFW Strain % RV EDVI (ml/m2) RV ESVI (ml/m2) 3D RV EF % AMS (9) 40.2±2.3 5/4 1/2 16±1.7 38.2±2.7 14±1.9 55±3.7 35±2.4 36±3.2 High-Landers (6) 53.6±3.7 5/1 1/1 20±2.7 46.9±4.7 28±2.2 52±4.1 29±2.8 45±2.3

Fig 1

Conclusion

Strain or myocardial deformation analysis based on two-dimensional (2D) speckle tracking and 3D RV ejection fraction is feasible even in the remote altitudes and allow accurate quantification which has resulted in a growing interest to introduce this new technique in analysis of acute mountain sickness.
P619Stress-strain loop area better represents regional myocardial work than pressure-strain loop area in the dyssynchronous and remodelled left ventricle
Authors: Duchenne J , Cvijic M , Turco A , Unlu S , Pagourelias E D , Bezy S , Vunckx K , Nuyts J , Claus P , Gheysens O , Rega F , Voigt J U
Published: October 2019

Background

Pressure-strain-loops (PSL) have been suggested as surrogate parameter of regional myocardial work. However, in left ventricles (LV) with inhomogeneous remodelling, e.g. due to left bundle branch block (LBBB), wall stress may be unevenly distributed. Stress-strain loops (SSL) include information on both regional wall thickness and curvature, and may therefore provide a better surrogate.

Study plan

We therefore compared the correlation of segmental myocardial work estimated through both PSL and SSL to segmental myocardial glucose metabolism as a gold standard, in an animal model of pacing-induced LV remodelling.

Methods

Twelve sheep developed LV dilatation, thinned septum and thickened lateral wall, due to eight weeks of rapid right-atrial and right-ventricular free wall (DDD) pacing (at 180 bpm), causing a LBBB-like dyssynchrony. Invasive LV pressure and echocardiographic speckle tracking based circumferential strain were used to construct PSL. SSL were calculated by considering in addition dynamic changes in segmental myocardial wall thickness and curvature using the formula of Laplace. 18F-fluorodeoxyglucose (FDG)-uptake was measured by positron emission tomography (PET) in absolute values as standardised uptake ratio (SUR). Spatial resolution of PET was improved by ECG- and breathing-gating and using anatomical priors. All imaging was performed during dyssynchronous DDD-pacing and synchronous AAI-pacing (right-atrial pacing only), at baseline (n=3 animals), and after eight weeks of pacing induced remodelling (n=12 animals).

Results

Both at baseline (Fig. A+B) and after 8 weeks (Fig. D+E), switching between AAI and DDD-pacing caused an acute re-distribution of regional myocardial work as measured by both PSL and SSL. In contrast to PSL, however, SSL identified more regional differences among walls in remodelled hearts and showed clearer regional changes when switching between AAI and DDD-pacing. The correlation between regional work, assessed by PSL and SSL, and metabolism by PET, was comparable at baseline (r=0.65 and r=0.64, respectively) (Fig. C). In remodelled hearts after 8 weeks, however, the correlation of regional work assessed by SSL and glucose uptake by PET was significantly higher compared to PSL (r=0.73 vs. r=0.59, respectively; p<0.05) (Fig. F).

Conclusions

Regional myocardial work assessed by stress-strain loops correlates significantly better to regional metabolism as measured by PET glucose uptake, particularly after remodelling. Our findings therefore suggest that integrating information on wall thickness and curvature is essential for the reliable assessment of regional myocardial work, especially in dyssynchronous and remodelled left ventricles.
P622Role of right ventricular strain measured by 2D-echocardiography in the diagnosis of cardiac amyloidosis
Authors: Durante Lopez A , Monivas Palomero V M P , Torres Sanabria M T S , Segovia Cubero J S C , Mingo Santos S M S
Published: October 2019

Introduction

Cardiac amyloidosis (CA) causes a restrictive cardiomyopathy usually associated with a poor prognosis. Two subtypes predominate: systemic (ALCA) and transthyretin (ATTR, either wild type -TTRwt- or mutant -TTRm-). Left ventricle (LV) apical sparing has been extensively studied by speckle-tracking echocardiography (STE) for diagnosis, but right ventricular (RV) deformation pattern has not been described.

Purpose

To characterize RV involvement in CA patients and to identify which parameters may help in the differential diagnosis between ALCA and ATTR subtypes.

Methods

78 patients with CA (47 ALCA, 20 TTRwt, 11 TTRm) and 24 healthy controls were included. We analyzed global longitudinal strain (GLS) in 16 LV and 6 RV segments. LV and RV apical ratios (AR) were obtained.

Results

LVGLS and Free-Wall RVLS were impaired in all patients (LVGLS: 11.9±2.9% in ALCA, 12.5±3.8% in TTRwt, 14.9±2.7% in TTRm, 21.9±2.6 in controls and Free-Wall RVLS: 13.1±6.8% vs 14.9±4.5% vs 17.2±3.4% vs 22.1±3.1, respectively). LV and RV AR were higher in ALCA as compared to both TTRwt, ATRm and controls (LVAR: 1.1±0.2 vs 0.8±0.2 vs 0.9±0.1 vs 0.7±0.1, p<0.001; RVAR: 1.1±0.2 vs 0.6±0.2 vs 0.6±0.1 vs 0.6±0.1, p<0.001). Cut-off values of LVAR>0.96 and RVAR>0.8 showed high accuracy to differentiate between ALCA and ATTR.

Conclusion

RV disfunction is a common finding in CA. Apical sparing pattern was present in RV strain, similarly to that described in LV and we describe it as an specific finding of ALCA patients. We propose RVAR as an accessible and easy way to differentiate, among different subtypes of amyloidosis based on STE analysis.
P630Role of Indian yoga with pranayam prevent ventricular remodeling and reduce mortality rate according to LV ejection fraction in post PCI patients of STEMI
Authors: Sen N , Tanwar S , Jain A , Mehta A , Shah N , Gokhroo R K , Dhall A
Published: October 2019

Background

Coronary revascularization is fruitful management to relieve angina and reduce mortality as compare to medical management in significant coronary artery stenosis. Although measurement of left ventricular ejection fraction (LVEF) after acute myocardial infarction (MI) is a performance measure, little is known about the relationship between EF and post-discharge mortality among MI patients in contemporary clinical practice.

Objectives

To assessment of mortality according to left ventricular ejection fraction and compare between yoga group and non yoga group, so that we can evaluate the importance of yoga and pranayam.

Methods

2,470 patients (25 to 68 years of age) with STEMI were registered and managed with percutaneous coronary intervention at three centres from 2010 to 2012. Method was used to assess the association between left ventricular ejection fraction (LVEF) measured during the index hospitalization and 5-year mortality from date of registry. The relationship was examined with EF as a categorical variable, utilizing four clinically relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%), and also with EF as a continuous variable. We divided two groups, group A was yoga with pranayam (n=1470) and group B was normal group (n=1000).

Results

Among STEMI patients we found a graded inverse association between EF category and mortality. For patients relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%) mortality after 5 years was assessed by 21%, 14.3%, 12.2% and 11% in yoga, pranayam group (p<0.004). For patients relevant categories (EF ≤34%, 35 to 45%, 46 to 54%, and ≥55%) mortality after 5 years was assessed by 25%, 17.5%, 14.4% and 13% in normal group (p<0.004). LVEF was increased in yoga & pranayam group by 11±3% versus 4±1% non yoga group.

Conclusion

Yoga and Pranayam; breathing exercise may help to reduce metabolic stress, reduce oxygen demand and prevent ventricular remodeling. Low LVEF after STEMI remains an important risk factor for post-discharge mortality, even after extensive adjustment for patient and hospital characteristics. Routine yoga and pranayam; breathing exercise may reduce the mortality after myocardial infarction.
P631Socioeconomic status; how does it influence referral to cardiac rehabilitation after acute myocardial infarction?
Authors: Graversen C B , Johansen M B , Johnsen S P , Riahi S , Holmberg T , Larsen M L
Published: October 2019

Background

The number of patients with low socioeconomic status who are referred to cardiac rehabilitation (CR) has been documented to be relative lower than patients with high SES among all patients hospitalised with acute myocardial infarction (AMI).

Purpose

The aims of this study were to evaluate the referral process to CR and how it is influenced by socioeconomic variables.

Methods

In 2011–2014, 1229 patients were hospitalised with AMI at Department of Cardiology of our University Hospital, Denmark. All were evaluated for participation to CR. Socioeconomic status was measured by personal income, educational level, marital status, and employment and obtained from national registers. Multiple logistic regression assessed socioeconomic determinants in three phases of the referral process to CR: 1. information about CR, 2. wish to participate in CR, and 3. referral to specialiced- or municipality-based CR. All analyses were adjusted for sex, age, and comorbidities.

Results

A total of 1123 (91.4%) patients received information regarding CR. Of these, 854 (69.5%) patients wished to participate in the programme. Income was the most important socioeconomic variable when looking at who were informed about CR (OR 2.17, 95%-CI: 1.0- 4.64) and who wished to participate in CR (OR 1.55, 95%-CI: 1.02–2.35).

Characteristics of study participants Characteristics All participants STEMI NSTEMI UAP n=1229 n=402 n=711 n=116 Male (n, %) 907 (73.8) 322 (80.1) 503 (70.7) 82 (70.7) Age Group (yrs)   <65 591 (48.1) 227 (56.5) 308 (43.3) 56 (48.3)   65–74 371 (30.2) 116 (28.9) 215 (30.2) 40 (34.5)   ≥75 267 (21.7) 59 (14.7) 188 (26.4) 20 (17.2) Baseline Comorbidity   Hypertension 241 (19.6) 62 (15.4) 148 (20.8) 31 (26.7)   Diabetes 14 (1.1) <5 (<1) 8 (1.1) <5 (<1) Charlson Comorbidity Index   Low (0 points) 1088 (88.5) 358 (89.1) 630 (88.6) 100 (86.2)   Moderate/High (>0) 141 (11.5) 44 (10.9) 81 (11.4) 16 (13.8) Civil status (n, %)   Married/Partnership 793 (64.5) 253 (62.9) 449 (63.2) 91 (78.4)   Divorced/Unmarried/Widow 436 (35.5) 149 (37.1) 262 (36.8) 25 (21.6) Occupational status (n, %)   Employed 479 (39.0) 195 (48.5) 240 (33.8) 44 (37.9)   Unemployed/Retired 750 (61.0) 207 (51.5) 471 (66.2) 72 (62.1) Educational status (n, %)   Low 516 (42.0) 144 (35.8) 322 (45.3) 50 (43.1)   Medium 539 (43.9) 201 (50.0) 293 (41.2) 45 (38.8)   High 174 (14.2) 57 (14.2) 96 (13.5) 21 (18.1) Gross income, tertile (n, %)   Low 405 (33.0) 113 (28.1) 251 (35.3) 41 (35.3)   Medium 406 (33.0) 124 (30.8) 247 (34.7) 35 (30.2)   High 418 (34.0) 165 (41.0) 213 (30.0) 40 (34.5) STEMI: ST-elevated myocardial infarction; NSTEMI: non-ST-elevated myocardial infarction; UAP: unstable angina pectoris.

Conclusion

Two out of three patients received referral to CR. However, higher income was proportional with the likelihood of receiving information about CR and willingness to participate in the programme.

Acknowledgement/Funding

the Danish Heart Foundation
P637Effects of cardiac rehabilitation as independent predictor for favourable long term postoperative evolution in patients undergoing coronary artery bypass grafting
Authors: Iliuta L
Published: October 2019

Aim

1. To evaluate whether a supervised cardiac rehabilitation (CR) program improves physical capacity and quality of life (QoL) of patients with LV systolic dysfunction undergoing coronary artery bypass grafting (CABG) compared to patients training by their own.

2. To investigate LV diastolic function dynamics according to the results of tissue Doppler imaging (TDI) in these patients.

3. To define the echographic predictors for long term prognosis in these patients and their adjusted value for calculation of a preoperative risk score.

Material and method

Prospective randomized study on 665 CABG patients with LV systolic dysfunction (LVEF<35%), comparing 12 weeks of supervised exercise training (SET) 3 times per week to home-based training based upon public health recommendations of minimum level of physical activity. Patients were evaluated including TDI preoperatively and till 5 years postoperatively. The primary endpoints were the composites of death from any cause or hospitalization for cardiac causes and the secondary endpoints were changes in peak oxygen uptake and in physical capacity (measured with cardiopulmonary exercise testing), changes in health-related QoL and changes in physical activity level (measured with International Physical Activity Questionnary). Stastistical analysis used SYSTAT and SPSS programs.

Results

1. SET was more efficient in rehabilitating CABG patients being an independent predictor for a more favourable postoperative evolution, mostly in patients with normal LV diastolic filling pattern (LVDFP) (97,27%) compared with restrictive LV filling (89.83%). At 5 years postoperatively, cardiovascular event-free survival was significantly higher in nonrestrictive LVDFP group (74.94%) compared with restrictive LVDFP (55,75%).

2. Conventional transmitral diastolic Doppler indices before and after CABG remained unchanged. TDI showed significant improvement in SET group at 3 and 12 months postoperatively of both LV systolic (S: 6.1±0.9, 7.5±1.1 and 7.3±1.2cm/s) and diastolic function (e': 7.2±1.8, 8.3±1.4 and 8.8±1.5cm/s.; E/e' ratio: 17.8±2.1, 13.1±1.7 and 11.3±1.8; Vp 3.2±0.55, 2.4±0.28 and 1.9±0.26)

3. The main predictors for unfavorable evolution at 5 years postoperatively were: age >75 years (RR=7.3), LV end-systolic volume (LVESV) >85cm3 (RR=6.4), restrictive LVDFP (RR=8.9) and pulmonary hypertension (PHT) (RR=5.2).

Conclusions

1. SET improves physical capacity and QoL in CABG patients, mainly in those with normal LVDFP, the restrictive LVDFP being associated with an early and late postoperative unfavourable evolution and difficult CR.

2. Exercise capacity and symptoms are more closely correlated with indices assessed by TDI which demonstrate significant improvement of LV systolic and diastolic function in SET patients, regardless of transmitral flow pattern

3. On long term postoperatively the unfavorable evolution was predicted by: age>75 years, LVESV>85cm3, restrictive LVDFP and severe PHT.
P640Sex differences in cardiovascular and all-cause mortality in middle-aged and older participants of a medically-supervised exercise program
Authors: Araujo C G , De Souza E Silva C G , Nishijuka F A , Laukkanen J A , Franca J F , Castro C L
Published: October 2019

Background

Physical inactivity has been shown to be associated with all-cause mortality in both healthy and unhealthy middle-aged and older individuals. While regular exercise is equally recommended for men and women, it is virtually unknown if sex influences the long-term survival among participants of a medically-supervised exercise program (MSEP).

Purpose

To evaluate if cardiovascular and all-cause mortality differs between men and women who participates in a MSEP.

Methods

Retrospective data from an open cohort of individuals aged 36 to 85 years old (66% men) who participated in a private MSEP between March 1994 and December 2018 were analyzed. The participants were free to attend the exercise sessions anytime from 6 a.m. to 9:30 p.m. (Monday to Friday) or 7 a.m. to 4 p.m. (Saturday). In median, the participants completed 47 sessions (1 to 5992 sessions) and attended for 6 months. Exercise sessions last between 60–80 minutes on average and included aerobic, muscle power, flexibility and balance exercises for all participants. Depending on clinical condition, gross and fine motor coordination, inspiratory muscle and isometric handgrip training were also performed under direct supervision of a multiprofessional team. Before each exercise session, the participant was briefly assessed by the exercise physician amd the aerobic exercise part was individually prescribed based on pre-participation evaluation/previous session data. Kaplan-Meier survival curves were separately determined for men and women - cardiovascular and all-cause mortality - and statistically compared by log rank test.

Results

Men and women had identical mean ages of 62.5 years-old (p>0.99) and median follow-up was 11 years, ranging from 0.1 to 24.8 years. From a total of 2,238 participants wit different disorders (68% with coronary artery disease), 465 died (21%), with almost three times higher death rate for men (15.1%) as compared to women (5.7%) (p<0.001). Cardiovascular deaths were 27% of total and also proportionally more frequent in men than women (HR 0.63, 95% CI 0.44–0.9; p=0.012). Women had a higher long-term overall survival rate than men (83% vs. 77%, respectively, HR 0.66, 95% CI 0.55–0.80; p<0.001).

Conclusion

Long-term cardiovascular and all-cause mortality were much higher in men than women that participated in a MSEP and these differences could not be explained by age. Future studies are needed to explain these findings and to analyze if men and women in MSEP would need similar dose of exercise for better survival benefit.

Acknowledgement/Funding

CNPq/FAPERJ/Health State Secretary
P644Relative fat mass (RFM) is a better predictor of dyslipidemia and metabolic syndrome than body mass index (BMI)
Authors: Kobo O , Leiba R , Avizohar O , Karban A
Published: October 2019

Background

The best adiposity measure to help predict cardiovascular risk factors has remained controversial. Relative fat mass (RFM), had been recently developed. We aimed to examine RFM predictability to various cardiometabolic risk factors, compared to BMI.

Methods

Observational, cohort study, among patients who visited the Periodic Examinations Institute [PEI]. We analysed the correlation between BMI and RFM to hypertension, impaired fasting glucose, high LDL, low HDL and metabolic syndrome, by gender. Using ROC curves, we identified the ideal value of RFM for identification of metabolic syndrome.

Results

During study years, 20,167 patients visited the PEI and included in the trial. Compared to BMI, RFM showed significantly better predictability (HR, [95% CI, p value]) of high LDL [1.618 (1.441–1.816, p<0.001) vs 0.732 (0.67–0.8, p<0.001) in men; 1.572 (1.377–1.794, p<0.001) vs. 0.938 (0.849–1.163, p=0.94) in women], low HDL [2.944 (2.569–3.373, p<0.001) vs. 2.177 (2–2.369, p<0.001) in men, 2.947 (2.519–3.448, p<0.001) vs 1.9 (1.658–2.176, p<0.001) in women], high triglycerides [4.019 (3.332–4.847, p<0.001) vs 1.994 (1.823–2.181, p<0.001) in men, 3.93 (2.943–5.247, p<0.001) vs. 2.24 (1.887–2.62, p<0.001) in women] and metabolic syndrome [7.479, (4.876–11.47, p<0.001) vs 3.263 (2.944–3.616, p<0.001) in men, 16.247 (8.348–31.619, p<0.001) vs 5.995 (5.099–7.048, p<0.001) in women]. There was no significant difference in the predictability of BMI and RFM to hypertension and diabetes mellitus. The ideal values of RFM for identification of metabolic syndrome were 27.7 for men and 39.8 for women.

Conclusions

RFM provides high predictability for dyslipidemias and metabolic syndrome in men and women.